radical nephrectomy

radical nephrectomy,

the surgical removal of a kidney, usually performed in the treatment of cancer of the kidney.

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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.

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radical nephrectomy

Surgery Excision of a kidney, the adrenal gland, adjacent lymph nodes, and other surrounding tissue