Nephrectomy (synonyms: simple lumbar nephrectomy; radical nephrectomy; radical tumor nephrectomy; kidney removal) is the surgical removal of a kidney. Nephrectomy is required when the kidney is irreversibly (irreversibly) damaged. A kidney can also be removed as part of an organ donation. In this case, it is called a donor nephrectomy.
The following forms of nephrectomy are distinguished:
- Simple nephrectomy-only the affected kidney is removed; adrenal glands, fat capsule, gerota fascia (connective tissue sheath surrounding the fat capsule), and lymph nodes are preserved
- Indication: benign (benign) disease.
- Radical nephrectomy – removal of the affected kidney and, in addition, the adrenal gland, fat capsule, gerota fascia, and regional lymph nodes.
- Indication: malignant (malignant) tumor.
Indications (areas of application)
- Benign (benign) diseases:
- Congenital (congenital) anomalies.
- Nephrolithiasis (kidney stones)
- Renal tuberculosis
- Recurrent nephritis (recurrent inflammation of the kidneys).
- Shrinking kidney (nephrocirrhosis)
- Injury to the kidney due to an accident (renal trauma).
- Hydronephrosis (water bag kidney)
- Malignant (malignant) diseases:
- Tumor diseases such as renal cell carcinoma (hypernephroma).
Contraindications
- Blood clotting disorders
Before surgery
- Before surgery, the patient must be informed or educated in detail about the procedure and any risks or side effects, and must give written consent.
- Discontinuation of anticoagulants (anticoagulants) – Discontinuation of anticoagulants such as acetylsalicylic acid (ASA) or Marcumar should be done in consultation with the attending physician. Discontinuing medication for a short period of time significantly minimizes the risk of rebleeding without a significant increase in risk to the patient. If there are diseases that can affect the blood clotting system and are known to the patient, this must be communicated to the attending physician.
The surgical procedures
Nephrectomy can be performed by open surgery through a flank or abdominal incision (preferred for larger tumors) or by laparoscopy (laparoscopy). The operation is performed under anesthesia.
Possible complications
- Bleeding, secondary bleeding
- Nerve or vascular damage
- Skin and tissue damage
- Wound healing disorders and wound infections
- Suture insufficiency
- Incisional hernia (scar hernia)
- If there is injury to neighboring organs such as the liver, intestines, and spleen during surgery: peritonitis (peritonitis), ileus (intestinal paralysis/bowel obstruction).
- Injury to the pleura, rarely pneumothorax (accumulation of air between the visceral pleura (lung pleura) and the parietal pleura (chest pleura)) or pleural effusion (pathologic (abnormal) increase in fluid content between the parietal pleura (chest pleura) and the visceral pleura (lung pleura))
- Adhesions in the abdominal cavity (abdominal cavity) → chronic pain, ileus (intestinal obstruction).
- Thrombosis (formation of blood clots), pulmonary embolism (occlusion of a pulmonary artery by a thrombus (blood clot)).
- Storage damage
