Nephrectomy

A nephrectomy is the surgical removal of a kidney, performed to treat a number of kidney diseases including kidney cancer. It is also done to remove a normal healthy kidney from a living or deceased donor, which is part of a kidney transplant procedure.

A nephrectomy is the surgical removal of a kidney, performed to treat a number of kidney diseases including kidney cancer. It is also done to remove a normal healthy kidney from a living or deceased donor, which is part of a kidney transplant procedure. ==History== The first recorded nephrectomy was performed in 1861 by Erastus B. Wolcott in Wisconsin. The patient had had a large tumor and the operation was initially successful, but the patient died fifteen days later. The first planned nephrectomy was performed by the German surgeon Gustav Simon on August 2, 1869, in Heidelberg. Simon practiced the operation beforehand in animal experiments. He proved that one healthy kidney can be sufficient for urine excretion in humans. ==Indications== There are various indications for this procedure, including renal cell carcinoma, a non-functioning kidney (which may cause high blood pressure) and a congenitally small kidney (in which the kidney is swelling, causing it to press on nerves, which can cause pain in unrelated areas such as the back). Nephrectomy for renal cell carcinoma is rapidly being modified to allow partial removal of the kidney. Nephrectomy is also performed for the purpose of living donor kidney transplantation. A nephroureterectomy is the removal of a kidney and the entire ureter and a small cuff of the bladder for urothelial cancer of the kidney or ureter. ==Procedure== The surgery is performed with the patient under general anesthesia. A kidney can be removed through an open incision or by laparoscopic surgery. For the open procedure, the surgeon makes an incision in the side of the abdomen to reach the kidney. Depending on circumstances, the incision can also be made midline. The ureter and blood vessels are disconnected, and the kidney is then removed. The laparoscopic approach utilizes three or four small (5–10 mm) cuts in the abdominal and flank area. The kidney is completely detached inside the body and then placed in a bag. One of the incisions is then expanded to remove the kidney for cancer operations. If the kidney is being removed for other causes, it can be morcellated and removed through the small incisions. Recently, this procedure is performed through a single incision in the patient's navel. This advanced technique is called single port laparoscopy. A total nephrectomy is the removal of at least the entire kidney, whereas a 'radical nephrectomy' also includes at least some perinephric fat, possibly including Gerota's fascia, and usually also the ipsilateral adrenal gland. For some illnesses, there are alternatives today that do not require the extraction of a kidney. Such alternatives include renal embolization for those who are poor candidates for surgery, or partial nephrectomy if possible. Occasionally renal cell cancers can involve adjacent organs, including the inferior vena cava (IVC), the colon, the pancreas or the liver. If the cancer has not spread to distant sites, it may be safely and completely removed surgically via open or laparoscopic techniques. ==After care== Pain medication is often given to the patient after surgery for pain at the site of the incision. An IV with fluids is administered. Electrolyte balance and fluids are carefully monitored, because these are the functions of the kidneys. It is possible that the remaining kidney does not take over all functionality. A patient may have to stay in the hospital between 2 and 7 days depending on the procedure and complications. Patients who have had open surgery will have to stay in hospital longer than those who have had laparoscopic surgery. Over the long-term, a person with only one kidney ("solitary kidney") may be more prone to developing chronic kidney disease (CKD). A 2014 study suggested that the lifelong risk of CKD is several-fold higher in kidney donors, although the absolute risk is still very small. A 2017 article in the New England Journal of Medicine suggested that persons with only one kidney, including those who have donated a kidney for transplantation or those whose kidney was removed for cancer, should avoid a high protein diet and limit their protein intake to less than one gram per kilogram body weight per day in order to reduce the long-term risk of CKD. ==See also== Kidney donation List of surgeries by type ==References== ==External links== Drawings of the steps of the procedure MedlinePlus Medical Encyclopedia: Nephrectomy Explanation of the surgery, the risks and the recovery

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