mizes the risk for permanent damage to the kid-
neys.
See also GLOMERULONEPHRITIS; GLOMERULOSCLERO-
SIS; NEPHRON.
nephrectomy A surgical OPERATIONto remove a
kidney. The most common reasons for nephrec-
tomy are to treat RENAL CANCER, to remove a kid-
ney for live donor KIDNEY TRANSPLANTATION, and to
remove a kidney that is severely injured due to
trauma or malformed due to CONGENITAL ANOMALY.
There are three kinds of nephrectomy:
- partial nephrectomy, in which the surgeon
removes only a portion of the kidney - simple nephrectomy, in which the surgeon
removes the entire kidney though leaves the
surrounding tissue intact - radical nephrectomy, in which the surgeon
removes the kidney, surrounding tissues, and
adjacent lymph nodes
Nephrectomy may be an open surgery, in
which the surgeon operates through a large inci-
sion in the flank (side of the back), or laparo-
scopic, in which the surgeon operates through
multiple small incisions using a laparoscope.
Surgical Procedure
Nephrectomy takes place in a hospital operating
room with the person under general ANESTHESIA.
For open nephrectomy, the surgeon makes a large
incision into the flank over the kidney. The incision
gives access to the kidney without the need to pen-
etrate the peritoneum, as the KIDNEYSlie behind this
protective membrane. The surgeon sutures off the
renal ARTERYand VEINand the URETER, then carefully
cuts the kidney away from the adipose tissue that
surrounds it and holds it in place. When the opera-
tion is radical nephrectomy for renal cancer, the
surgeon also removes the adipose tissue, nearby
connective tissue, and adjacent lymph nodes. After
removing the kidney the surgeon sutures closed
the incision, which will heal into a SCAR. Open
nephrectomy takes two to four hours.
For laparoscopic nephrectomy, also called mini-
mally invasive nephrectomy, the surgeon makes
four or five small incisions, called ports, in loca-
tions around the flank on the side where the kid-
ney will be removed. The surgeon inserts the
laparoscope through one of the ports, and uses
another to inflate the interior of the abdomen
with a gas. The surgeon inserts instruments
through the remaining ports. The laparoscope has
a light and camera on the tip that conveys the
image of the interior abdomen to a closed-circuit
television monitor. The surgeon operates by
watching the monitor. When the kidney is free
from its BLOODsupply and connecting tissues, the
surgeon inserts a special bag through one of the
ports and puts the kidney into it. The surgeon
carefully delivers the bag through the port, enlarg-
ing the port if necessary. When the kidney is out,
the surgeon removes the instruments and laparo-
scope from their ports and sutures them closed.
The ports heal into small scars. Laparoscopic
nephrectomy takes three to five hours.
After either type of surgery, the person remains
in the recovery room until fully awakened from
the anesthesia and then goes to a hospital room.
The hospital stay for open nephrectomy is gener-
ally five to seven days and for laparoscopic
nephrectomy is generally three to five days. A
person who undergoes open nephrectomy typi-
cally returns to regular activities in 8 to 12 weeks.
A person who undergoes laparoscopic nephrec-
tomy typically returns to regular activities in five
to six weeks.Risks and Complications
The primary risks of nephrectomy are bleeding
and INFECTION, along with the potential for compli-
cations arising from anesthesia. These are uncom-
mon events. The doctor will prescribe ANALGESIC
MEDICATIONSto relieve postoperative PAIN. Further
risks depend on the reasons for the nephrectomy.
Some people experience fluctuations in BLOOD
PRESSURE during the first few days after the
nephrectomy, as the kidneys are key to regulating
blood pressure in the body. This nearly always sta-
bilizes without the need for treatment.Outlook and Lifestyle Modifications
Most people fully recover and return to their regu-
lar activities after nephrectomy. The remaining kid-
ney, if healthy, can more than adequately sustain
the body’s needs. People who have renal cancer
often undergo follow-up CHEMOTHERAPYor RADIA-206 The Urinary System