Nephrectomy

There are two surgical approaches to a nephrectomy:

• Open nephrectomy
• Laparoscopic/robotic-assisted nephrectomy

Open nephrectomy

During an open nephrectomy, the surgeon uses a sharp knife (scalpel) to make a cut (incision) in your side or abdomen. The incision may be as long as 12 inches (30 centimeters). The surgeon looks directly inside your body and doesn’t use a camera. A surgeon may recommend an open nephrectomy if you have a large kidney tumor or a partial nephrectomy if they can remove the tumor without risk to the remainder of your kidney.

Laparoscopic/robotic-assisted nephrectomy

This is a less invasive approach. During a laparoscopic surgery, the surgeon uses a laparoscope to perform the surgery. A laparoscope is a thin, metal tool with a camera at the end. A laparoscopic nephrectomy uses several small incisions (less than an inch, typically 0.5 cm to 1 cm) instead of a large incision. Typically, the surgeon will increase one incision in size to extract the kidney or kidney tumor. A robotic-assisted laparoscopic nephrectomy uses a surgical robot. The surgeon controls the robot to manipulate the small tools in areas that are difficult to reach.

The group of healthcare providers that make up your care team during a nephrectomy generally includes:

• A urologist
• An anesthesiologist
• Nurses

The anesthesiologist will sedate you with general anesthesia. You’ll be asleep, won’t move and won’t feel any pain during the procedure. After you’re asleep, a nurse or physician will insert a urinary catheter to drain any pee from your bladder.

During a radical or partial laparoscopic nephrectomy, the urologist will:

• Use a scalpel to make one or several small incisions in your abdomen or side (flank)
• Insert a laparoscope through an incision
• View the camera image from the laparoscope on a large screen
• Insert a small tube into an incision to fill your abdominal cavity with carbon dioxide gas (insufflation) — the gas separates the abdominal wall from your organs so it’s easier to see and move the surgical instruments
• Insert a few additional tubes (ports) that allow the urologist to easily switch instruments, such as graspers or scissors
• Move your bowel away from the kidney and identify blood vessels that transport blood into and out of the kidney
• Either permanently close and cut those blood vessels (for a radical nephrectomy) or temporarily place clamps to block blood flow (partial nephrectomy)
• Use small surgical tools to remove the diseased portion of your kidney or your entire kidney
• If necessary, remove any affected lymph nodes, the adrenal gland and part of the ureter
• Release the carbon dioxide gas from your abdomen (some gas will remain behind)
• Possibly insert a surgical drain into the incision to help drain excess fluids as you heal
• Close the incision(s) with small stitches (sutures) that will later dissolve on their own after your incision heals, surgical staples or both

During a radical or partial open nephrectomy, the urologist will:

• Use a scalpel to make an incision in your abdomen or flank
• Examine your kidney and the surrounding area to make sure damage hasn’t spread
• Either permanently close and cut those blood vessels for a radical nephrectomy or temporarily place clamps to block blood flow for a partial nephrectomy
• Use small surgical tools to remove the diseased portion of your kidney or your entire kidney
• Insert a surgical drain to prevent fluid buildup and help with healing
• Close the incision with sutures, staples or both

On average, a nephrectomy can take two to four hours to complete. But it can take longer according to your anatomy. Your surgeon will give you a better idea of what to expect.

Immediately after a nephrectomy, the care team will:

• Cover your affected areas with a surgical glue or bandage
• Stop putting anesthesia into your body (you’ll wake up in a few minutes, but you’ll probably still feel groggy and nauseated)
• Send the kidney, tumor or both to a laboratory for testing (pathology)
• Move you to a recovery room, where they’ll wait for you to wake up more fully and track your overall health
• Treat your pain and teach you pain management techniques

Your healthcare team will monitor your blood pressure, blood chemistry, electrolytes and fluid levels. You may need to avoid solid foods for a day or two after surgery. Liquids help give your body time to recover.

Usually, within a day after surgery, providers will encourage you to walk. Walking helps the healing process by promoting blood flow to the area. Walking can also help reduce your risk of developing other complications, including blood clots in your legs (deep vein thrombosis).

Because an incision will be near your diaphragm, breathing deeply may be uncomfortable. Providers will teach you diaphragmatic breathing exercises. These exercises, laying with your upper body propped up and walking are important for preventing pneumonia.

Typically, the day after surgery, a provider will remove the urinary catheter.

After a nephrectomy, you’ll stay in the hospital for one to five days. Your hospital stay depends on what type of nephrectomy you have and other factors.

Once your care team determines you’re well enough, they’ll let you go home. You may still have pain or difficulty moving, so a family member or friend must drive you home. It’s a good idea to have a friend or family member help take care of you for at least a few days after the procedure, too.

Yes, a nephrectomy is a major surgery. It’s an inpatient procedure, which means most people stay in the hospital for at least one or more days for observation and rehabilitation as they recover.

Most people have two kidneys at birth. But you can function and lead a fulfilling life with only one functional kidney.

If a healthcare provider removes both of your kidneys, you’ll need a kidney transplant or dialysis to remain alive.

After a nephrectomy, your remaining kidney increases in size and does more work within a few days to increase its ability to filter your blood and remove waste.

A healthcare provider will conduct kidney function tests about six weeks after the procedure to monitor the health and function of your remaining kidney. The provider will give you instructions on how often you need these tests.