Kidney Removal

Kidney removal, or nephrectomy, is surgery to remove all or part of a kidney. It may involve:

Part of one kidney removed (partial nephrectomy)
All of one kidney removed (simple nephrectomy)
Removal of one entire kidney, surrounding fat, and the adrenal gland (radical nephrectomy). In these cases, neighboring lymph nodes are sometimes removed.

Alternative Names

Nephrectomy; Simple nephrectomy; Radical nephrectomy; Open nephrectomy; Laparoscopic nephrectomy; Partial nephrectomy

Description

This surgery is done in the hospital while you are asleep and pain-free (general anesthesia). The procedure can take 3 or more hours.

Simple nephrectomy or open kidney removal:

You will be lying on your side. Your surgeon will make an incision (cut) up to 12 inches (30 centimeters) long. This cut will be on your side, just below the ribs or right over the lowest ribs.
Muscle, fat, and tissue are cut and moved. Your surgeon may need to remove a rib to do the procedure.
The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed.
Sometimes, just a part of the kidney may be removed
The cut is then closed with stitches or staples.

Radical nephrectomy or open kidney removal:

Your surgeon will make a cut about 8 to 12 inches (20 to 30 centimeters) long. This cut will be on the front of your belly, just below your ribs. It may also be done through your side.
Muscle, fat, and tissue are cut and moved. The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed.
Your surgeon will also take out the surrounding fat, and sometimes the adrenal gland and some lymph nodes.
The cut is then closed with stitches or staples.

Laparoscopic kidney removal:

Your surgeon will make 3 or 4 small cuts, usually no more than 1 inch (2.5 centimeters) each, in your belly and side. The surgeon will use tiny probes and a camera to do the surgery.
Towards the end of the procedure, your surgeon will make one of the cuts larger (around 4 inches or 10 centimeters) to take out the kidney.
The surgeon will cut the ureter, place a bag around the kidney, and pull it through the larger cut.
This surgery may take longer than an open kidney removal. However, most people recover faster and feel less pain after this type of surgery when compared to the pain and recovery period following open surgery.

Sometimes, your surgeon may make a cut in a different place than described above.

Some hospitals and medical centers are doing this surgery using robots.

Open Article Detail

Why the Procedure Is Performed

Kidney removal may be recommended for:

Someone donating a kidney
Birth defects
Kidney cancer
A kidney damaged by infection, kidney stones, or other problems
To help control high blood pressure in someone who has problems with the blood supply to their kidney
Very bad injury (trauma) to the kidney that cannot be repaired

Risks

Risks for any surgery are:

Blood clots in the legs that may travel to the lungs
Breathing problems
Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
Blood loss
Heart attack or stroke during surgery
Reactions to medications

Risks for this procedure are:

Injury to other organs or structures
Kidney failure in the remaining kidney
After one kidney is removed, your other kidney may not work as well for awhile
Hernia of your surgical wound

Before the Procedure

Always tell your health care provider:

If you could be pregnant
What drugs you are taking, even drugs or herbs you bought without a prescription

During the days before the surgery:

You will have blood samples taken in case you need a blood transfusion.
You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), Clopidogrel (Plavix), warfarin (Coumadin), and other blood thinners.
Ask your provider which drugs you should still take on the day of the surgery.
Do not smoke. This will help you to recover quicker.

On the day of the surgery:

You will most often be asked not to drink or eat anything after midnight the night before the surgery.
Take the drugs as you have been told, with a small sip of water.
You will be told when to arrive at the hospital.

After the Procedure

You will stay in the hospital for 2 to 7 days, depending on the type of surgery you have. During a hospital stay, you may:

Be asked to sit on the side of the bed and walk on the same day of your surgery
Have a tube, or catheter, that comes from your bladder
Have a drain that comes out through your surgical cut
Not be able to eat the first 1 to 3 days, and then you will begin with liquids
Be encouraged to do breathing exercises
Wear special stockings to prevent blood clots
Receive shots under your skin to prevent blood clots
Receive pain medicine into your veins or pills

Recovering from open surgery may be painful because of where the surgical cut is located. Recovery after a laparoscopic procedure is most often quicker, with less pain.

Outlook (Prognosis)

The outcome is most often good when a single kidney is removed. If both kidneys are removed, or the remaining kidney does not work well enough, you will need hemodialysis or a kidney transplant.

References

Kavoussi LR, Schwartz MJ, Gill IS. Laparoscopic surgery of the kidney. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 55.

Kenney PA, Wotkowicz T, Libertino JA. Contemporary open surgery of the kidney. In: Wein AJ, ed. Campbell-Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011:chap 54.