The surgical removal of a kidney is called a nephrectomy, performed by a urologic surgeon. This operation treats kidney cancer or serious diseases that have damaged the organ beyond repair. Nephrectomy is also used to remove a healthy kidney from a living donor for transplantation. Surgery varies from a partial nephrectomy, removing only a diseased section, to a radical nephrectomy, which removes the entire organ.
Preparing for the Procedure
Preparation for a nephrectomy begins with a comprehensive medical evaluation. This assessment includes physical examinations, blood work to check overall health and kidney function, and urinalysis. Imaging studies, such as CT scans or MRIs, provide the surgical team with a precise map of the kidney’s location, surrounding blood vessels, and any tumors.
Discussions cover the plan for general anesthesia, ensuring the patient is unconscious and pain-free. A pre-operative step involves adjusting medications, particularly blood thinners, which must be temporarily stopped to minimize bleeding risk. Patients are also instructed to fast after midnight before surgery to prevent anesthesia complications.
On the day of the procedure, a final check of the patient’s identity, allergies, and the surgical site is performed for safety. Patients may be asked to shower with a special antiseptic soap to reduce the risk of surgical site infection.
Surgical Techniques for Kidney Removal
The method used to remove the kidney influences the recovery process, utilizing two main approaches: open surgery and minimally invasive techniques. Open nephrectomy is the traditional method, requiring a single, large incision, typically in the flank or abdomen, for direct access. This approach is generally reserved for complex cases, such as very large tumors or cancer spread.
During an open procedure, the surgeon separates the kidney from surrounding tissues, clamps and divides the renal artery and vein, and severs the ureter. The organ is extracted through the large incision, allowing for direct visualization and control of bleeding. This technique involves a longer hospital stay and extended recovery due to the incision size and muscle cutting.
Minimally invasive techniques, including laparoscopic and robotic-assisted nephrectomy, are the standard approach for most kidney removals, especially for living donors. These procedures use several small incisions, or ports, through which a camera and specialized instruments are inserted. The abdomen is inflated with carbon dioxide gas to create a working space for the surgeon.
The surgeon uses the instruments to dissect the kidney, detaching it from surrounding fat and muscle. The renal artery, vein, and ureter are sealed and divided using specialized clips or stapling devices. The detached kidney is placed in a surgical bag, and one small incision is slightly enlarged for extraction. This less invasive method results in less blood loss, less pain, and a shorter hospital stay compared to the open technique.
Immediate Recovery and Hospital Stay
Following surgery, the patient is transferred to a recovery unit and monitored while waking from anesthesia. During the initial 24 to 72 hours, the medical team tracks vital signs and urine output to confirm the remaining kidney is functioning properly. Immediate effects like grogginess, incision pain, and nausea are common and managed with medication.
Patients often have a catheter placed to drain urine and may have a small drain tube near the surgical site to remove excess fluid. Pain control is a significant focus, involving a Patient-Controlled Analgesia (PCA) pump or regular oral pain medications. Early mobilization is strongly encouraged; nurses assist the patient in walking a short distance, sometimes within hours of the procedure.
Walking helps prevent serious complications like blood clots and aids in restoring normal bowel function. The hospital stay depends on the surgery type: minimally invasive patients are often discharged within one to two days, while open surgery patients may remain for three to five days. Before discharge, the patient must manage pain with oral medication, tolerate liquids and food, and walk independently.
Long-Term Adjustment and Follow-Up
Living with a single kidney is entirely possible, as the remaining organ compensates for the loss by increasing its filtration capacity, a process known as compensatory hypertrophy. A healthy single kidney can perform the work of two kidneys, allowing most individuals to live a normal life. However, this single organ must be carefully protected, as there is no backup system should it become damaged.
Long-term care involves regular follow-up appointments to monitor the function of the remaining kidney. These visits include blood tests to check the glomerular filtration rate (GFR) and creatinine levels, which indicate how well the kidney is filtering waste. Urine tests are also performed to check for protein, an early sign of kidney strain or damage.
Lifestyle recommendations center on protecting the solitary kidney, including maintaining excellent hydration by drinking plenty of water. Managing blood pressure is also important, as high blood pressure can damage the kidney’s filtering units over time. While most activities can be resumed, individuals are advised to consider avoiding high-impact contact sports, like football or boxing, to minimize the risk of traumatic injury.