Radical nephrectomy is a surgical procedure in which the entire kidney is removed, sometimes along with other parts like the adrenal gland, lymph nodes, and surrounding fatty areas around the kidney. If a person is healthy, they can function normally with one kidney. This procedure is performed for certain conditions that include kidney cancer, damaged kidney because of infection or trauma, and in the case of kidney transplant for donation.
Kidney cancer surgery
Kidneys, adrenal glands, and surrounding tissues
How is a radical nephrectomy performed?
Radical nephrectomy can be performed in two ways under general anesthesia. Laparoscopic surgery is a minimally invasive procedure in which a surgeon makes small holes and inserts a small camera (laparoscope) to get a look inside the lesion and perform the surgery using surgical tools attached to the laparoscope. The incision or cut can be slightly big if more tissues are to be removed. Laparoscopic surgery can also be performed via robot assistance, in which the robotic system performs the surgery under the surgeon’s control. On the other hand, in open surgery, an incision is made on the abdomen, and surgery is performed. Open surgery is performed in cases where lesion removal is not possible by the laparoscopic procedure, especially where the whole kidney is removed along with its associated structures.
Preparation before the surgery
Before proceeding towards surgery, certain tests are performed to evaluate the patient’s health and wellbeing. The choice of surgery, whether laparoscopic or open, depends on the size of the lesion to be removed. The doctor also briefs the patients about what to do and avoid before undergoing surgery and certain tests that include:
- Routine tests: Blood profile (complete blood count, prothrombin tests, blood group, etc.), liver and kidney function tests.
- Urine analysis: Urine tests like urea, uric acid, creatinine tests.
- Medications: The patients are asked to stop blood-thinning medications 7-10 hours before the procedure.
- Preoperative testing: Clearance from the heart and medicine department, which involves taking chest X-rays, ECG, and blood tests, should be taken before proceeding towards the surgery to prevent any complication.
- Diet: The patient should have an empty stomach on the day of surgery. Usually, overnight fasting is recommended.
After the surgical procedure, a catheter is inserted into the bladder to pass the urine. The patient is asked for a follow-up by the surgeon between 3-7 days of the surgery. The physical examination of the wound and some clinical tests like blood pressure, urine filtration, protein analysis of urine, etc., are performed to check normal kidney function. The catheter is also checked, and some medications are advised to prevent infections and aid in the recovery process.
Risks associated with a radical nephrectomy
The risk associated with a radical nephrectomy is the same as with any other surgical procedure which may involve:
- Post-surgical infection: It is common after any surgical procedure and can be avoided by taking appropriate care of the wound and antibiotics.
- Post-surgical bleeding: It is another common issue after any surgery that can happen if there is a tear or friction over the wound.
- In the case of a transplant, if there is some existing infection in the kidney, the transplantation may fail.
Recovery after a radical nephrectomy
The recovery after a radical nephrectomy usually takes 6-12 weeks, which also depends on the individual’s overall general health. The catheter is usually kept for some time after the surgery and is checked by the surgeon on every follow-up visit. The healthcare provider may recommend certain dietary changes and after some follow-up visits, may suggest the patient go for a walk in order to return to normal functions. The blood pressure and kidney functions are closely monitored over the years to keep the patient in the best optimal condition.