What are the other Names for the Procedure?
- Partial Nephrectomy
- Radical Nephrectomy
What is Kidney Removal surgical procedure?
Kidney Removal (or Nephrectomy) is a surgical procedure that involves the removal of a kidney.
What part of the Body does the Procedure involve?
The Kidney Removal procedure involves a kidney, the surrounding blood vessels attached to the kidney, and ureters. The ureter is a tube that carries urine from the kidney to the bladder.
Why is the Kidney Removal surgical procedure Performed?
A Kidney Removal procedure is performed for the following reasons:
- Removal of suspected cancerous tumor within a kidney
- Severely damaged kidney
- Kidney failure
- For transplantation of a kidney, from a donor to a recipient
What are some Alternative Choices for the Procedure?
A Kidney Removal or Nephrectomy is the preferred procedure of choice in certain serious kidney diseases/conditions, and is often the only available treatment modality.
What are the Recent Advances in the Procedure?
Advances in Nephrectomy include:
- The use of laparoscopic techniques: This technique allows for smaller incisions. Tubes containing camera and the instruments are introduced into the abdomen, via these incisions (called ports) and the procedure is performed. The recovery time following a laparoscopic procedure is shorter and there is lesser pain
- Da Vinci Partial Nephrectomy: In this method, smaller incisions or ports are made, similar to a laparoscopic technique. Additionally, the da Vinci system makes use of a robotic technology. The da Vinci system converts the surgeons hand movements into more precise movements of the surgical instruments inside the body. This allows for greater precision, lesser complications, and shorter duration of hospital stay
What is the Cost of performing the Kidney Removal surgical procedure?
The cost of Kidney Removal surgical procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Kidney Removal surgical procedure and what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
- Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
www.surgery.com/procedure/nephrectomy (accessed on 08/02/2014)
http://www.davincisurgery.com/da-vinci-urology/da-vinci-procedures/da-vinci-partial-nephrectomy.php (accessed on 08/02/2014)
Prior to Kidney Removal surgical procedure:
How is the Kidney Removal surgical procedure Performed?
The Kidney Removal (Nephrectomy) procedure is performed in the following manner:
- The surgeon makes a skin incision on either the flank or on the front of the belly, below the ribcage
- After dissecting through the layers of the abdominal wall, the abdominal organs are visualized. The kidney and its blood vessels are then visualized
- After clamping the blood supply to the kidney and the ureter, the surgeon removes the kidney either in portions (partial) or entirely (along with a portion of the ureter; in which case the procedure is termed a Simple Nephrectomy)
- Sometimes, the kidney is removed along with adjacent structures (part of the ureter, adrenal gland found on top of the kidney, and surrounding fat); a procedure termed Radical Nephrectomy, which is performed in some cases of cancer
- The vessels and the ureter are sutured. The abdominal wall is then closed in layers, and the incision wound is sutured
Where is the Procedure Performed?
Generally, a Kidney Removal (Nephrectomy) procedure is performed at a hospital.
Who Performs the Procedure?
An urologist or a general surgeon performs a Kidney Removal procedure.
How long will the Procedure take?
A Kidney Removal procedure may take up to 3 hours.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Kidney Removal surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for Kidney Removal procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Kidney Removal surgical procedure?
Before a Kidney Removal procedure, the patient has to undergo certain tests, such as:
- Routine blood and urine analysis
- X-rays of the kidney, chest, and lower gastrointestinal tract region
- Electrocardiography (ECG)
- Ultrasound imaging
- Intravenous pyelogram (IVP)
- Magnetic resonance imaging (MRI) scan and computerized tomography (CT) scan
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Kidney Removal procedure?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is it an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- How many such procedures have you (the physician) performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- What are the costs involved?
During the Kidney Removal surgical procedure:
What kind of Anesthesia is given, during the Procedure?
General anesthesia by injection and inhalation is administered, prior to the Kidney Removal procedure.
How much Blood will you lose, during the Procedure?
During the Kidney Removal procedure, while some blood loss is to be expected, a substantial loss does not occur, unless there is an injury to any major blood vessel.
What are the possible Risks and Complications during the Kidney Removal surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the Kidney Removal surgery are:
- Excessive bleeding
- Infection in the surgical wound
- Formation of blood clots
- Anesthetic complications
- Accidental injury to the vena cava, or to other neighboring organs surrounding the kidney
What Post-Operative Care is needed at the Healthcare Facility after the Kidney Removal surgical procedure?
- After the Kidney Removal surgical procedure, the patients will be sent to an area of the hospital, called a postoperative recovery area (or PACU)
- The patient’s blood pressure, heart rate, and respiration cycle, shall be closely monitored. Any additional pain associated with the procedure will be treated
- Individuals are usually discharged from the hospital, 3-5 days after the surgery is performed
After the Kidney Removal surgical procedure:
What are the possible Risks and Complications after the Kidney Removal surgical procedure?
The possible risks and complications that may arise after Kidney Removal surgery are:
- Excessive bleeding
- Infection in the surgical wound
What is the Prognosis after the Surgery?
A complete recovery from a Kidney Removal procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Pain that worsens and swelling around the surgical wound
- Bleeding or fluid drainage from the surgical wound
- The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, abnormal swelling within the abdomen, and constipation
- Signs of an infection
- Fever, feeling sick
- Muscle aches, headaches
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Kidney Removal surgical procedure?
At home, the following post-operative care is recommended, after a Kidney Removal procedure:
- Slowly resume regular/daily activities as early as possible, which aids in a faster recovery
- Use a heat pad or warm compress to relieve pain due to the incision
- Resume showering and keep the wound clean and dry. Avoid taking baths, until the surgical wound is completely healed. Gently wash the surgical wound with an unscented soap
- Complete the course of prescribed medication, as advised by your physician
- Take stool softeners to prevent constipation
- Take antibiotic medications to help combat or prevent infection, as advised by your physician
- Avoid taking nonprescription medications, such as aspirin. However, individuals may take acetaminophen to relieve pain (under advise from the physician)
- Avoid all activities that are physically strenuous for about 6 weeks after surgery
- Resume driving only after 5 weeks of being discharged from the hospital, or when advised by your physician
- Avoid sex, till complete healing has taken place (under advise by the physician)
- Individuals are advised to have to clear liquids immediately after surgery, until the gastrointestinal tract begins functioning properly. Then, individuals are advised to have a well-balanced diet, which can aid in a faster recovery
How long does it normally take to fully recover, from the Procedure?
It usually takes approximately 4 weeks to fully recover from a Kidney Removal surgery.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and later disposed as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision.
- Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued.
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Kidney Removal surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The outpatient facility, physician’s office or hospital
- An anesthesiologist (if anesthesia was administered)
- A pathologist (if the tissue was sent for analysis)
- A general surgeon or a urologist
The patient is advised to inquire and confirm the type of billing, before the Kidney Removal procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA