Procedure– Nephrectomy means removal of one kidney. This operation is done for various indications and its name changes according to the disease for which its being done. For example simple nephrectomy is done for a kidney which is either non functioning or non salvageable due to serious infection or trauma. Radical nephrectomy is the terminology used for malignant/ cancerous  conditions of kidney. During a radical nephrectomy, the urologic surgeon removes the entire kidney and often some additional structures, such as part of the tube that connects the kidney to the bladder (ureter), or other adjacent structures such as the adrenal gland or lymph nodes. After nephrectomy patient survives on one kidney only.

Nephrectomy operation can be done by Laparoscopic or open approach.

Laparoscopic / Robotic Radical Nephrectomy– In this operation 4-5 small holes of 5-10 mm size are made on the abdomen and kidney operation is performed. After the kidney is dissected from the body, its removed by a small incision of approximately 5 cm size. Post operative pain is lesser than an open approach and recovery is faster. However, many a times operation is converted to open due to some intraoperative difficulty like adhesions, bleeding, abnormal anatomy,decreased oxygen saturation etc. The decision to convert to open surgery is taken during the operation depending upon the situation hence patient has to be ready for both open and laparoscopic approach.

Open Simple/ radical Nephrectomy- In open surgery the incision is given on the flank and is about 15 -20 cm long. Here the 12 rib is excised for proper exposure of the kidney. The stitches are placed in several layers to close the incision site. The stitches on the skin are cut after 2 weeks

Hospital stay- Total hospital stay in such cases varies from 4-6 days depending upon the recovery of the patient. Patient may be kept in the ICU for one day to monitor the parameters.

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.

Risks and complications –

1. Bleeding requiring blood transfusion- Nephrectomy is a major surgery so blood is always arranged and kept in blood bank for any intraoperative or postoperative blood transfusion need. Such transfusions are needed in 13% of patients.
2. Infection_-post operative wound infection may happen in 10% of cases which may require prolonged antibiotics and dressing.
3. Visceral complications- Injury to the surrounding organs of kidney like Liver, Spleen, Lungs, duodenum, Pancreas, colon or diaphragm may happen which require immediate measures to repair it. Such incidence is rare and happens in lesser than 15% of patients.
4. Pneumonia- In 13 % of patient respiratory problems like atelectasis or pneumonia may arise due to anesthesia effect. Post operative pain may sometimes pose difficulty in breathing especially in open surgery in obese or old patients.
5. Anesthesia related complications like chest infection, vomiting, headache may occur for few days in some patients.
6. Reoperation is carried out in 3.0% of the cases for some post operative complications. Overall mortality rate (<30 days) is 3.1%.
7. Deep venous thrombosis (DVT) and thromboembolism- This means formation of blood clots in large veins of limb which may migrate to distant veins/ lungs and heart. This is a rare phenomenon and reported in <1% of patients.
8. 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 that leads to gradual deterioration of kidney function and hence increased blood urea and creatinine level. Those patients who already have decreased function of opposite normal kidney may need dialysis to filter out the waste products.