Radical Nephrectomy

There are different types of radical nephrectomy:

• Open radical nephrectomy. During an open radical nephrectomy, the surgeon uses a sharp knife (scalpel) to carefully make a cut (incision). The incision may be as long as 12 inches (30 centimeters). The surgeon may recommend open surgery if you have a larger kidney tumor or if they need to remove all of the surrounding lymph nodes.
• Laparoscopic radical nephrectomy. During a laparoscopic radical nephrectomy, the surgeon uses a thin metal instrument with a camera at the end (laparoscope) to perform the surgery. Laparoscopic surgeries use several small incisions (less than an inch, typically 0.5 cm to 1 cm) instead of one large incision. Laparoscopic radical nephrectomy is more common than open nephrectomy.
• Robotic radical nephrectomy. During a robotic radical nephrectomy, the surgeon controls a surgical robot. The robot has arms that hold tiny instruments. The instruments enter your body through several small incisions instead of one large incision. A robotic approach has many of the same advantages as a laparoscopic approach.

A special group of healthcare providers make up the care team during a radical nephrectomy, including:

• 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 will insert a urinary catheter to drain any pee from your urinary bladder.

During an open radical nephrectomy, the urologist (surgeon) will:

• Use a scalpel to make an incision and examine the kidney and its surrounding area to make sure the cancer hasn’t spread
• Use clamps to block the blood vessels that transport blood into and out of the area
• Remove the kidney and some fatty tissue
• If necessary, they’ll remove any affected lymph nodes, the adrenal gland and part of your ureter (the ureter is a tube of muscle that carries pee from your kidneys to your urinary bladder)
• The surgeon may insert a surgical drain into the incision to help drain blood and other excess fluids as you heal
• Close the incisions with stitches and/or staples

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

• Use a scalpel to make three to five small incisions in your side
• Insert a laparoscope into an incision (the laparoscope projects video to a monitor above the operating table)
• Insert a small tube into an incision to your abdominal cavity with carbon dioxide gas (the gas separates your abdominal wall from your organs so it’s easier to see and move the surgical instruments)
• Clamp the blood vessels in the area
• Using the monitor as a guide, insert small surgical tools through into the incisions to remove your kidney, some fatty tissue and any other affected organs or tissue
• Release the gas from your abdomen
• Close the incisions with stitches and/or staples

A radical nephrectomy can take three or more hours to complete.

Immediately after a radical nephrectomy, your care team will:

• Cover your affected areas with a bandage
• Stop putting anesthesia into your body (you’ll wake up in a few minutes, but will probably still feel groggy)
• Send the kidney tumor to the pathology lab for testing
• 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

You’ll avoid solid foods for a day or two after surgery. Liquids will help give your body time to recover. As you heal, providers will reintroduce you to solid foods.

Usually 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 the chance of other complications, including blood clots in your legs and pneumonia.

As early as the morning after surgery, a provider will remove the urinary catheter.

Once your care team determines you’re healthy, 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 family member or friend take care of you for at least a few days after the procedure, too.