A nephrectomy is a surgical operation to remove either a portion or the entire kidney. This procedure can involve excising just the affected section or the whole organ, and may also include the removal of nearby adrenal glands and lymph nodes. It is commonly performed to address kidney cancer, along with various kidney diseases and injuries that impair kidney function. For further details, refer to “Indications for nephrectomy.”
Types of nephrectomy
Depending on the reason for having a nephrectomy, different types of surgery may be recommended:
Simple nephrectomy
A simple surgery of nephrectomy in Turkey involves removing the entire kidney. An incision is made through which the kidney’s blood vessels and their connections to the bladder are cut. The surgeon then removes the organ.
Partial nephrectomy
This procedure involves removing only part of the kidney, where a tumor is located. After reaching the kidney and temporarily interrupting blood circulation inside it, the surgeon removes the pathological part of the kidney and then reconstructs the organ so that its anatomy is restored, without bleeding or urine leaking from inside the kidney.
Radical (complete) nephrectomy
During a radical nephrectomy, the surgeon removes the entire kidney and often some additional structures, such as the adrenal gland or nearby lymph nodes.
Nephroureterectomy
This procedure is similar to radical nephrectomy, but in this case the entire ureter (connecting channel to the bladder) must be removed. This surgery is indicated when there is a tumor originating in the urothelium of the upper urinary tract (the mucous layer lining the channels that carry urine).
Indications for nephrectomy
The kidneys are vital organs in the urinary system, located at the “back” of the abdomen and protected by the lower ribs. Their function is to filter the blood and remove waste products, control fluid balance and regulate the amount of electrolytes. As the kidneys filter the blood, urine is produced, which is then excreted through the urinary tract.
The most common reason for nephrectomy is to remove a tumor in the kidney. These tumors are usually cancerous and malignant (kidney cancer), however, surgery may also be recommended in the case of some benign tumors.
However, tumors and cancers of the kidney are not the only reasons why a nephrectomy may be necessary. There are a wide variety of problems that can affect the proper functioning of the kidneys:
- Injuries to the kidney;
- Renal insufficiency;
- Chronic kidney infections;
- Acquired renal atrophy (for example, after prolonged obstruction of the ureter);
- Congenital kidney deformities (smaller or larger than normal kidneys);
- In cases of kidney donation, surgery is also required to remove the healthy kidney from a donor;
- Among others.
Preparing for nephrectomy
Preparation for a nephrectomy for a patient with some underlying pathology should be guided by the specialist doctor in charge of the surgery. It is necessary to fast (not eat or drink) for 6 hours prior to surgery.
In the case of nephrectomy for a kidney transplant in Turkey, the preparation is different. In order to be assessed as a kidney donor, the person must be healthy and free of diseases that could lead to kidney failure (e.g. diabetes, high blood pressure, etc.). The potential donor is then tested to assess compatibility with the transplant candidate. These tests are carried out to detect possible complications that could lead the recipient’s body to reject the new kidney.
How is a nephrectomy performed?
Any type of nephrectomy is performed under general anesthesia. Before the surgery begins, a urinary catheter (a small tube that drains urine from the bladder) will be inserted into the patient.
All types of nephrectomy (simple, partial, radical, nephroureterectomy) can be performed using different surgical methods. The choice of method to use in each case depends on various factors, such as:
- the characteristics of the disease to be treated (e.g. size and location of the tumor to be removed);
- the surgeon’s experience in each of the techniques;
- the availability of resources at each center.
Thus, the existing surgical approaches for nephrectomy are:
Laparoscopic surgery (conventional or robotic)
In this minimally invasive procedure, the surgeon makes a few small incisions in the patient’s abdomen in order to insert devices equipped with video cameras (laparoscope) and small surgical tools.
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Laparoscopy has the same objectives as traditional surgical techniques (open surgery) and can be used for both radical and partial nephrectomy.
More recently, robotic surgery has been introduced. Robotic-assisted laparoscopy, as the name suggests, uses a robotic system to perform the procedure.
These robotic tools are controlled by the surgeon himself, allowing for greater precision in the operation. The advantages over conventional laparoscopy are particularly in challenging cases, such as complex partial nephrectomies.
Because it is less invasive than open surgery, with less bleeding and a faster, less painful recovery, laparoscopy is the preferred route whenever technically feasible. However, even in cases where the laparoscopic route is initially chosen, difficulties or complications may arise during the intervention that may justify switching to the open route (in a process called “conversion”).
Open surgery
In an open nephrectomy, the surgeon makes an incision along the patient’s abdomen until they reach the kidney. The ureter and blood vessels are cut and the kidney is removed through the incision.
This is the classic approach, which involves making an incision in the abdominal or lumbar region in order to reach the kidney. Today, it is used above all in more complex cases – tumors that are bulky or difficult to detach from the rest of the kidney (in the case of partial nephrectomy), with thrombi in the vein or enlarged lymph nodes (adenopathies), where the laparoscopic approach can be more complex or less safe.