nephrectomy

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Related to Complete nephrectomy: Partial nephrectomy

Nephrectomy

 

Definition

Nephrectomy is the surgical procedure of removing a kidney or section of a kidney.

Purpose

Nephrectomy, or kidney removal, is performed on patients with cancer of the kidney (renal cell carcinoma); a disease in which cysts (sac-like structures) displace healthy kidney tissue (polycystic kidney disease); and serious kidney infections. It is also used to remove a healthy kidney from a donor for the purposes of kidney transplantation.

Precautions

Because the kidney is responsible for filtering wastes and fluid from the bloodstream, kidney function is critical to life. Nephrectomy candidates suffering from serious kidney disease, cancer, or infection usually have few treatment choices but to undergo the procedure. However, if kidney function is lost in the remaining kidney, the patient will require chronic dialysis treatments or transplantation of a healthy kidney to sustain life.

Description

Nephrectomy may involve removing a small portion of the kidney or the entire organ and surrounding tissues. In partial nephrectomy, only the diseased or infected portion of the kidney is removed. Radical nephrectomy involves removing the entire kidney, a section of the tube leading to the bladder (ureter), the gland that sits atop the kidney (adrenal gland), and the fatty tissue surrounding the kidney. A simple nephrectomy performed for transplant purposes requires removal of the kidney and a section of the attached ureter. A similar procedure is used to harvest cadaver kidneys, although both kidneys are typically removed at once (bilateral nephrectomy) and blood and cell samples for tissue typing are also taken.
The nephrectomy patient is administered general anesthesia and the surgeon makes an incision on the side or front of the abdomen. Muscle, fat, and tissue are cut away to reveal the kidney. The blood vessels connecting the kidney to the circulation are cut and clamped. Depending on the type of nephrectomy procedure being performed, the ureter, adrenal gland, and/or surrounding tissue may also be cut. The vessels and the ureter in the patient are then tied off and the incision is sewn up (sutured). The surgical procedure can take up to three hours, depending on the type of nephrectomy being performed.
Laparoscopic nephrectomy is a form of minimally-invasive surgery that utilizes instruments on long, narrow rods to view, cut, and remove the kidney. The surgeon views the kidney and surrounding tissue with a flexible videoscope. The videoscope and surgical instruments are maneuvered through four small incisions in the abdomen. Once the kidney is freed, it is secured in a bag and pulled through a fifth incision, approximately 3 in (7.6 cm) wide, in the front of the abdominal wall below the navel. Although this surgical technique takes slightly longer than a traditional nephrectomy, preliminary studies have shown that it promotes a faster recovery time, shorter hospital stays, and less postoperative pain for kidney donors.

Preparation

Prior to surgery, blood samples will be taken from the patient to type and crossmatch in case transfusion is required during surgery. A catheter will also be inserted into the patient's bladder. The surgical procedure will be described to the patient, along with the possible risks.

Aftercare

Nephrectomy patients may experience considerable discomfort in the area of the incision. Patients may also experience numbness, caused by severed nerves, near or on the incision. Pain relievers are administered following the surgical procedure and during the recovery period on an as-needed basis. Although deep breathing and coughing may be painful due to the proximity of the incision to the diaphragm, breathing exercises are encouraged to prevent pneumonia. Patients should not drive an automobile for a minimum of two weeks.

Risks

Possible complications of a nephrectomy procedure include infection, bleeding (hemorrhage), and post-operative pneumonia. There is also the risk of kidney failure in a patient with impaired function or disease in the remaining kidney.

Key terms

Cadaver kidney — A kidney from a brain-dead organ donor used for purposes of kidney transplantation.
Polycystic kidney disease — A hereditary kidney disease that causes fluid- or blood-filled pouches of tissue called cysts to form on the tubules of the kidneys. These cysts impair normal kidney function.
Renal cell carcinoma — Cancer of the kidney.

Normal results

Normal results of a nephrectomy are dependent on the purpose of the procedure and the type of nephrectomy performed. Immediately following the procedure, it is normal for patients to experience pain near the incision site, particularly when coughing or breathing deeply. Renal function of the patient is monitored carefully after nephrectomy surgery. If the remaining kidney is healthy, it will increase its functioning over time to compensate for the loss of the removed kidney.
Length of hospitalization depends on the type of nephrectomy procedure. Patients undergoing a laparoscopic radical nephrectomy may be released within two to four days after surgery. Traditional open nephrectomy patients are typically hospitalized for about a week. Recovery time will also vary, on average from three to six weeks.

Resources

Organizations

National Kidney Foundation. 30 East 33rd St., New York, NY 10016. (800) 622-9010. http://www.kidney.org.

nephrectomy

 [nĕ-frek´to-me]
surgical removal of a kidney, a procedure indicated when chronic disease or severe injury produces irreparable damage to the renal cells. Tumors, multiple cysts, and congenital anomalies may also necessitate removal of a kidney.
Patient Care. The surgical incision for nephrectomy can be lumbar, retroperitoneal, transabdominal, thoracic, or thoracic abdominal. Upon the patient's return from the operating room the location of the surgical wound is immediately noted, as well as whether there are any tubes or drains exiting the wound. If the thoracic cavity has been entered, the patient will have one or more chest tubes. There may also be surgical drains for removal of serosanguineous fluid from the operative site.

Dressings over the wound are checked frequently and may be reinforced to keep the patient dry, but they are not changed without a written prescription to do so. The drainage on the dressings will be blood-tinged at first but should gradually become clearer. Hemorrhage is a major complication; hence, any appearance of bright red blood or a change in the amount of drainage is reported immediately. The kidney has a very rich supply of blood directly from the vena cava and aorta, so that if a ligature should slip, there could be substantial blood loss. The vital signs are therefore monitored closely and any signs of shock reported promptly. An intravenous line should be kept open in the event a transfusion is needed.

Sometimes the drain will have a safety pin attached to its end. The pin is kept closed at all times and is never attached to the dressings, the patient's gown, or the bedclothes. When dressings are reinforced or changed, care must be taken that drains and tubes are not dislodged or pulled from the surgical incision. All tubes and drains are checked frequently to assure that they are patent and draining freely. The exception, of course, is a chest tube attached to a closed system.

Positioning of the patient will depend on the site of the incision and the preference of the physician. Some may prefer that the patient lie only on the affected side to facilitate drainage and protect the remaining kidney. Turning, coughing, and deep breathing will produce some discomfort because of the location of the incision. However, adequate aeration of the lungs is essential. One also should watch for spontaneous pneumothorax, which can occur if the thoracic cavity has been entered accidentally during surgery.

Adequate drainage from the unaffected kidney is of extreme importance. Urinary output is monitored hourly at first and then at longer intervals to be sure there is normal renal function. Fluids may be restricted immediately after surgery and gradually increased as the remaining kidney compensates for the loss of its partner. A single kidney can carry out the work of two kidneys; thus a patient can survive a nephrectomy in good health.
radical nephrectomy removal of a kidney with its fascia, the adjacent adrenal gland, and all lymph nodes in the region; done for renal cell carcinoma.

ne·phrec·to·my

(ne-frek'tō-mē),
Removal of a kidney.
[nephr- + G. ektomē, excision]

nephrectomy

/ne·phrec·to·my/ (nĕ-frek´tah-me) excision of a kidney.

nephrectomy

(nə-frĕk′tə-mē)
n. pl. nephrecto·mies
Surgical removal of a kidney.

nephrectomy

[-ek′təmē]
Etymology: Gk, nephros, kidney, ektomē, excision
the surgical removal of a kidney, performed to remove a tumor or otherwise diseased kidney. In the patient with renal failure, the kidney may be the cause of extreme hypertension, and therefore one or both kidneys are removed. Before surgery the blood is typed and crossmatched for transfusion. During surgery the kidney is approached through either a flank, abdominal, or thoracoabdominal incision and removed. If the thoracic cavity is opened, a chest tube is inserted and connected to water-seal drainage. The nurse observes carefully for rapid pulse, restlessness, sweating, and a drop in blood pressure. Urinary output is measured hourly, and fluid intake and body weight are closely monitored. Deep breathing is difficult because the incision is close to the diaphragm. Pain medication is essential so that the patient can breathe deeply and move. The nurse reports at once any sudden shortness of breath and assesses the lungs for signs of spontaneous pneumothorax, which may occur if the pleura was accidentally nicked during surgery.
enlarge picture
Surgical position for a nephrectomy

nephrectomy

The surgical removal of a kidney.

nephrectomy

Surgery Surgical removal of a kidney. See Partial nephrectomy, Radical nephrectomy, Simple nephrectomy.

ne·phrec·to·my

(ne-frek'tŏ-mē)
Surgical removal of a kidney.
[nephr- + G. ektomē, excision]

nephrectomy

Surgical removal of a kidney. This may be necessary because of injury and severe bleeding, cancer, severe infection, malfunctioning from loss of blood supply or multiple stones. If the other kidney is healthy there is no apparent functional disadvantage from nephrectomy. One kidney provides ample kidney function to maintain health and allow full physical activity.

nephrectomy

surgical removal of a kidney. The procedure is indicated when chronic disease or severe injury produces irreparable damage to the renal cells. Tumors, multiple cysts and congenital anomalies may also necessitate removal of a kidney. A single healthy kidney can carry on the functions formerly performed by both kidneys.
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