Partial Nephrectomy

Overview

Most often a nephrectomy is performed to treat kidney cancer or to remove a noncancerous (benign) tumour. In some cases, a nephrectomy is performed to deal with a diseased or seriously damaged kidney. In the case of a donor nephrectomy, the urologic surgeon removes a healthy kidney from a donor for transplant into a person who needs a functioning kidney.

The urologic surgeon may perform a nephrectomy through a single incision in the abdomen or side (open nephrectomy) or through a series of small incisions in the abdomen using a camera and small instruments (laparoscopic nephrectomy).

In some cases, these laparoscopic procedures are performed using a robotic system. In robotic surgery, the surgeon sits at a computer console near the operating table. He or she controls the camera arm and mechanical arms, which have surgical instruments attached to them that are working inside the patient’s body.

Why it’s done

The most common reason a urologic surgeon performs a nephrectomy is to remove a tumour from the kidney. These tumours are usually cancerous, but they can be noncancerous (benign). Sometimes a nephrectomy is needed because of other kidney diseases.

Kidney function

Most people have two kidneys — fist-sized organs located near the back of the upper abdomen. Your kidneys:

• Filter wastes and excess fluid and electrolytes from your blood
• Produce urine
• Maintain proper levels of minerals in your bloodstream
• Produce hormones that help regulate your blood pressure and that influence the number of circulating red blood cells

Cancer treatment

Often a urologic surgeon performs nephrectomy to remove a cancerous tumour or abnormal tissue growth in a kidney. The most common kidney cancer in adults, renal cell carcinoma, begins in the cells that line the small tubes within your kidneys.

Kidney tumours in children are rare. But when they occur, children are more likely to develop a type of kidney cancer called Wilms’ tumour, probably caused by the poor development of kidney cells.

The decision about how much kidney tissue to remove depends on:

• Whether a tumour is confined to the kidney
• Whether there is more than one tumour
• How much of the kidney is affected
• Whether the cancer affects nearby tissue
• How well the other kidney functions
• Whether other diseases affect kidney function
• Overall kidney function

The urologic surgeon makes a decision based on the results of imaging tests, which may include:

• Computerized tomography (CT), a specialized X-ray technology that produces images of thin cross-sectional views of soft tissues
• Magnetic resonance imaging (MRI), which uses a magnetic field and radio waves to produce cross-sectional views or 3-D images
• Ultrasound, an image of soft tissues produced with the use of sound waves

Treatment for other conditions

A partial or radical nephrectomy may be needed to remove severely damaged, scarred or non-functioning kidney tissue due to traumatic injury or other diseases.

Risks

Nephrectomy is generally a safe procedure. But as with any surgery, nephrectomy carries a potential risk of complications, such as:

• Bleeding
• Infection
• Injury to nearby organs
• Rarely, other serious problems

Long-term complications from a nephrectomy relate to potential problems of living with less than two complete, fully functioning kidneys. Although overall kidney function decreases after a nephrectomy, the remaining kidney tissue usually works well enough for a healthy life.

Problems that may occur with long-term reduced kidney function include:

• High blood pressure (hypertension)
• Chronic kidney disease

Potential risks and complications depend on the type of surgery, reasons for surgery, patient’s overall health and many other issues, including surgical expertise and experience. For example, at Mayo Clinic these procedures are performed by urologists with advanced training and extensive experience to minimize the chances of problems related to surgery and assure the best possible outcomes.

For a better understanding of potential risks it’s important that you discuss these issues with your urologic surgeon.

How you prepare

Before surgery, you’ll talk with your urologic surgeon about what options are available for you. Questions you might ask include:

• Will I need a partial or complete nephrectomy?
• Am I a candidate for a minimally invasive procedure (laparoscopic, robotic or other)?
• What are the chances that I’ll need a complete nephrectomy even if a partial nephrectomy is planned?
• If the surgery is for treating cancer, what other related procedures or treatments might I need?

Planning your hospital stay

You may need to stay in the hospital from one night to a week or more, depending on the type of procedure. Ask your surgeon and health care team about your probable recovery time.

Preparing for the surgery

You’ll receive instructions about what to do the day before and the day of your surgery. Make note of any questions you might have, such as:

• When do I need to begin fasting?
• Can I take my prescription medications?
• If so, how soon before the surgery can I take a dose?
• What non-prescription medications should I avoid?
• When do I need to arrive at the hospital?

What you can expect

A nephrectomy procedure is performed during general anaesthesia. You’ll receive a medication (aesthetic) before surgery so that you won’t be awake or feel pain during surgery. You’ll also have a urinary catheter — a small tube that drains urine from your bladder — placed before surgery. During the procedure, the urologic surgeon and anaesthesia team work together to minimise pain after surgery.

During the procedure

The nephrectomy procedure varies, depending on how the surgery is performed and how much of the kidney is removed. Variations include:

• Laparoscopic surgery. In this minimally invasive procedure, the surgeon makes a few small incisions in your abdomen to insert wand-like devices equipped with video cameras and small surgical tools. The surgeon must make a slightly larger opening if your entire kidney needs to be removed.
• Robot-assisted laparoscopic surgery. In a variation of laparoscopic surgery, the surgeon uses a robotic system to perform the procedure. Robotic tools require very small incisions, provide better 3-D images during the procedure, and can make fine or complex motions that are similar to what a surgeon’s hand can do in open surgery.
• Open surgery. In an open nephrectomy, the urologic surgeon makes a cut (incision) along your side or on your abdomen. This open approach allows surgeons to perform some surgeries that still can’t be performed safely with less invasive approaches.
• Radical nephrectomy. In a radical nephrectomy, the surgeon removes the whole kidney, the fatty tissues surrounding the kidney and a portion of the tube connecting the kidney to the bladder (ureter). The surgeon may remove the adrenal gland that sits atop the kidney if a tumour is close to or involves the adrenal gland. In some cases lymph nodes or other tissues are removed as well.
• Partial nephrectomy. In a partial nephrectomy — also called kidney-sparing (nephron-sparing) surgery — the surgeon removes a cancerous tumour or diseased tissue and leaves in as much healthy kidney tissue as possible.

Your urologic surgeon will discuss the advantages and disadvantages of robotic or other types of minimally invasive surgery versus open surgery, including issues such as scarring and the time it takes to return to normal activities.

After the procedure

Recovery time after the procedure and the length of your hospital stay depend on your overall health and the type of nephrectomy performed. The urinary catheter remains in place for a short time during your recovery.

Expect to receive instructions before leaving the hospital about restrictions to your diet and activities. You may be encouraged to begin light, everyday activities as soon as you feel able, but you’ll need to avoid strenuous activity or heavy lifting for several weeks.

For most patients, these procedures don’t affect quality of life — once you’re completely recovered, you can expect to resume your normal routine and activities.

Results

Questions that you may want to discuss with your urologic surgeon or other members of your health care team after your nephrectomy include:

• How did the surgery go overall?
• What did you learn from pathology about the tissue that was removed?
• How much of the kidney was preserved?
• How often will I need additional testing to monitor my kidney function and the disease that prompted the surgery?

Monitoring kidney function

Most people can function well with only one kidney or with one whole kidney and part of the second. You’ll likely have check-ups to monitor the following factors related to kidney function.

• Blood pressure. You’ll need careful monitoring of your blood pressure because decreased kidney function can increase blood pressure — and high blood pressure can, in turn, damage your kidney.
• Protein urine levels. High protein urine levels (proteinuria) may indicate kidney damage and poor kidney function.
• Waste filtration. Glomerular filtration rate is a measure of how efficiently your kidney filters waste. The test is usually performed with a sample of blood to measure the creatinine level. A reduced filtration rate indicates decreased kidney function.

Taking care of your remaining kidney

After a nephrectomy or partial nephrectomy, you may have overall normal kidney function. To preserve normal kidney function, your doctor may recommend that you eat a healthy diet, engage in daily physical activity and attend regular check-ups to monitor your kidney health.

If you develop chronic kidney disease (reduced kidney function) after complete or partial nephrectomy, your doctor may recommend additional lifestyle changes, including possible dietary changes and being careful about prescription and over-the-counter medications.