Nephrectomy is the surgical removal of a kidney

History

The first successful 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, such as 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.

Nephrectomy is the surgical removal of the kidney. When renal cell carcinoma has been found to
be the cause of a kidney mass, kidney tumor, or kidney pain surgical removal of the kidney or
part of the kidney (partial nephrectomy) is the common course of action. Another minimally
invasive procedure, cryotherapy is also used do destroy the kidney cancer.

Nephrectomy may be performed using several techniques which include the traditional open
nephrectomy, laparoscopic nephrectomy, and robotic nephrectomy. All of the above procedures
are performed under general anesthesia.

open radical nephrectomy, laparoscopic nephrectomy, minimally invasive robotic nephrectomy,

partial nephrectomy, or a cryoablation of the kidney (freezing),

Laparoscopic nephrectomy, open nephrectomy, and robotic nephrectomy are simply three
different ways to surgically remove the kidney. The open nephrectomy is the original way surgery
was done, by making an incision in the skin and have the surgeons place their hands inside the
body to operate and remove the kidney. The object behind removing the entire kidney is to be
sure all of the cancer is out of the body so it can not spread to other parts of the body. The job of
the kidneys is to filter out water and waste out of our blood. Since we have two kidneys having
one removed will not be a detriment to our lifestyle. However from that point on we no longer
have a back up kidney if the lone kidney has any problems such as infections, kidney stones,
UPJ obstruction, kidney tumor, kidney mass, diabetes, or renal cell carcinoma.

Laparoscopic nephrectomy is performed by making several small incisions to allow the

laparoscopic tubes to slide in the body. On of the laparoscopic instruments is a very small camera
that allows surgeons to view what they are doing up on a monitor. The other laparoscopic
instruments are for cutting, cauterizing, grasping, suturing, etc. Gas is blown into the body cavity
to open up the surgical area to give room for seeing the organs and room to move around to
perform the surgery.
Laparoscopic nephrectomy has several advantages over the open nephrectomy. Generally there
is less bleeding during and after the operation. The scars are much smaller and the healing time
is shorter. Shorter healing time also translates into a shorter hospital stay. Patients have less
discomfort and less pain with our minimally invasive laparoscopic nephrectomy Many times
patients can be back into their day to day lives faster and that includes going back to work. Since
every patient has their own set of circumstances, these positive trends that are seen are not
guarantees of outcomes.
Laparoscopic nephrectomy procedure preparations are similar to most surgeries. If you are taking
blood thinners such as aspirin, Plavix, or Coumadin they need to be discontinued as your
surgeon prescribes. A bowel prep the night before surgery and not drinking or eating anything
after 12 o’clock before your surgery. Twenty four hours prior to surgery you should go on a clear
diet which includes: water, juices (no tomato or orange juice), tea, and jello without fruit.

Partial nephrectomy is the removal of a cancerous kidney mass that is most often 1.6 inches (4
centimeters) or less. When a kidney tumor or kidney mass is found to be cancerous such as renal
cell carcinoma and the size of the cancer covers an area of 1.6 inches or less our experienced
team of Ivy League urologists have the skills and experience to perform all three kidney surgery
techniques of partial nephrectomy or a cryoablation of the kidney mass.

Partial nephrectomy may also be performed with laparoscopic instruments the advantages are:
less post procedure pain, less blood loss, quicker recovery and shorter hospital time. To qualify
for a laparoscopic partial nephrectomy the kidney mass needs to be 1.6 inches or less, the
kidneys are in good working order, overall health is good, and the kidney tumor is not in the
middle of the kidney. At the Miami urology center your preferences and concerns will be
addressed by our urologists and our medical staff to help you fill in the who, what, where, and
why’s that will help you make clear your understanding of your specific circumstance, your
options and what you can expect in the near and far future.

Kidney cryotherapy is another procedure that is offered at the Miami urology center in the Mount
Sinai Medical Center. Kidney cryotherapy or cryoablation of the kidney is a procedure that
freezes the tumor in the kidney, killing the renal cell carcinoma. Cryoablation of the kidney
freezes the kidney tumor to -100 degrees Celsius or 100 degrees Celsius below zero. Once the
tumor is frozen it is then thawed. It is during thawing that the cancer cells die. To make sure the
cancer cells die the tumor is frozen again and again thawed.

The “cryo” or freezing is performed by placing a needle(s) under ultrasound guidance

into the kidney tumor. The needles have passages in them that allow gas to flow in them
to freeze the metal needle(s) which turns the tumor into an ice ball. The urologist watches
the ice ball form in the kidney with ultrasound. Once the ice ball encompasses the whole
kidney tumor the freezing gas is sent out of the needles and another gas is sent into the
needle(s) causing the needle(s) to heat up and thaw the ice ball tumor. When the tumor is
thawed out the freezing gas is once again pumped in to freeze the kidney tumor a second
time and then thawed again to make sure the all the cancer cells are destroyed.

Purpose

Nephrectomy, or kidney removal, is performed on patients with severe kidney damage

from disease, injury, or congenital conditions. These include cancer of the kidney (renal
cell carcinoma); polycystic kidney disease (a disease in which cysts, or sac-like
structures, displace healthy kidney tissue); and serious kidney infections. It is also used to
remove a healthy kidney from a donor for the purposes of kidney transplantation .
Aftercare

Nephrectomy patients may experience considerable discomfort in the area of the incision.
Patients may also experience numbness, caused by severed nerves, near or on the
incision. Pain relievers are administered following the surgical procedure and during the
recovery period on an as-needed basis. Although deep breathing and coughing may be
painful due to the proximity of the incision to the diaphragm, breathing exercises are
encouraged to prevent pneumonia. Patients should not drive an automobile for a
minimum of two weeks.

Risks

Possible complications of a nephrectomy procedure include infection, bleeding

(hemorrhage), and post-operative pneumonia. There is also the risk of kidney
failure in a patient with impaired function or disease in the remaining kidney.
Open nephrectomy

In a traditional, open nephrectomy, the kidney donor is administered general

anesthesia and a 6–10 in (15.2–25.4 cm) incision through several layers of muscle
is made on the side or front of the abdomen. The blood vessels connecting the
kidney to the donor are cut and clamped, and the ureter is also cut between the
bladder and kidney and clamped. Depending on the type of nephrectomy
procedure being performed, the ureter, adrenal gland, and/or surrounding tissue
may also be cut. The kidney is removed and the vessels and ureter are then tied
off and the incision is sutured (sewn up). The surgical procedure can take up to
three hours, depending on the type of nephrectomy being performed.
Laparoscopic nephrectomy

Laparoscopic nephrectomy is a form of minimally invasive surgery that utilizes

instruments on long, narrow rods to view, cut, and remove the kidney. The
surgeon views the kidney and surrounding tissue with a flexible videoscope. The
videoscope and surgical instruments are maneuvered through four small
incisions in the abdomen, and carbon dioxide is pumped into the abdominal
cavity to inflate it and improve visualization of the kidney. Once the kidney is
isolated, it is secured in a bag and pulled through a fifth incision, approximately 3
in (7.6 cm) wide, in the front of the abdominal wall below the navel. Although this
surgical technique takes slightly longer than a traditional nephrectomy,
preliminary studies have shown that it promotes a faster recovery time, shorter
hospital stays, and less post-operative pain.

A modified laparoscopic technique called hand-assisted laparoscopic

nephrectomy may also be used to remove the kidney. In the hand-assisted
surgery, a small incision of 3–5 in (7.6–12.7 cm) is made in the patient's
abdomen. The incision allows the surgeon to place his hand in the abdominal
cavity using a special surgical glove that also maintains a seal for the inflation of
the abdominal cavity with carbon dioxide. This technique gives the surgeon the
benefit of using his hands to feel the kidney and related structures. The kidney is
then removed by hand through the incision instead of with a bag.