Nephrectomy - Procedure, Steps, Types & Recovery Time

Nephrectomy is derived from two Greek words, 'nephro', meaning kidney, and 'ectomy', meaning removal. This is a surgical procedure designed to extract a kidney or a portion of it. 

A urinary system specialist, called a urologic surgeon, performs this surgery. The technique is often employed to treat renal cell carcinoma, the most common type of kidney cancer in adults.

Anatomy and Physiology of the Kidney

The average adult kidney is about 12 cm long, 6 cm wide, and 3 cm deep. It has roughly 1-1.3 million nephrons (functional units of the kidney). It filters the waste from blood plasma, converts it into urine, and eliminates it from the body. Three layers surround each kidney, offering support and protection:

Kidney removal surgery is a major surgery.  It can be performed at any age; it's often considered for patients experiencing specific kidney issues. Understanding the situations that necessitate this can help in making informed decisions.

Here are some common conditions where nephrectomy can be a valuable solution:

1. Persistent Infections: If a kidney becomes a recurring source of infections that can't be controlled otherwise.

2. Diseased or Damaged Kidneys: This can be caused by various factors, including:

1. Kidney cancer
2. Congenital disabilities that affect kidney function
3. Severe infections or complications from kidney stones

3. Severe Kidney Injury: Some incidents can permanently damage a kidney, necessitating removal.

4. Potential Kidney Donor: A healthy kidney from a living donor can offer another person a chance to improve their life through a kidney transplant.

Nephrectomy, or the surgical removal of a kidney, can offer several significant benefits when dealing with various kidney problems:

1. In cases of CKD (chronic kidney disease), removing the diseased kidney can alleviate symptoms like fatigue, swelling, and difficulty urinating. 

2. It can also slow the progression of the disease and improve overall kidney function, potentially delaying the need for dialysis or a transplant.

3. Nephrectomy can eliminate the disease for persistent kidney infections that resist antibiotic treatment.

4. In kidney cancer or benign tumour cases, a nephrectomy can remove the cancerous or abnormal tissue. 

5. Potentially cure early-stage kidney cancer and restore the health of the remaining kidney.

Preparation is the key to a smooth nephrectomy (kidney removal) procedure. The surgeon will provide detailed instructions to follow the days before and on the day of the surgery.

Before  Nephrectomy

The individual is typically admitted to the hospital a day or two before for pre-surgery monitoring.  This allows the medical team to conduct necessary tests for the procedure. Other preparations are as follows:

On the Day of Nephrectomy 

The type of nephrectomy the doctor performs (complete or partial) will determine the length of the surgery. It can take up to 3 hours. Here are some requirements on the day of the procedure:

Regardless of whether the procedure is laparoscopic (minimally invasive) or open, nephrectomies are performed using general anaesthesia. This is to keep the patient comfortable and pain-free. The steps of nephrectomy are as follows:

Laparoscopic Nephrectomy

It is a minimally invasive approach that promotes quicker recovery with less operative pain for patients.

1. Four cuts are made in the patient's abdomen or side.

2. A camera (laparoscope) is inserted through one incision. This projects a magnified image of the kidney onto a large screen to visualise the area.

3. The surgeon removes either the diseased portion of the patient's kidney or the entire kidney itself.

4. A smaller opening, typically around 8 cm wide, is made in the lower abdomen, below the navel. This allows them to extract the kidney through this dedicated incision.

Open Nephrectomy

Open nephrectomy is a traditional surgical approach. This may be necessary in specific cases. 

1. A larger incision is made in the patient's abdomen to provide direct access to the kidney.

2. The surgeon directly removes the diseased part or the entire kidney.

3. The kidney operation stitches are performed to close the incisions.

Once fully awake and stable, the patient will be transferred to the recovery room. Healing begins immediately in the hospital and then continues at home. The following is a general guideline: 

After Nephrectomy 

The hospital stay following a nephrectomy ranges from one to five days. The exact duration depends on the type of nephrectomy performed. During this time, the patient's healthcare team will closely monitor several factors:

1. Vital signs like blood pressure, heart rate, and breathing will be regularly checked.

2. Blood tests assess the electrolyte and fluid balance in the body.

3. A urinary catheter (a hollow tube) drains urine from the bladder for 7 to 10 days. ¹⁹ ²º. However, this number of days can vary depending on the patient’s condition.

4. Chest physiotherapy exercises are recommended within 24 hours after the surgery to prevent lung infections. These help clear mucus from the lungs and promote deeper breathing.

Recovery in Hospital 

This period is essential for close monitoring and initiating recovery. This is essential to ensuring the body adjusts to the surgery.

1. On the first day after surgery, the patient will be advised to consume minimal food and fluids, allowing the digestive system time to recover.

2. Once the bowels function normally, a light diet and fluids will be gradually introduced. The transition can take one to three days.

3. The medical team will change the dressing on the incision as needed to promote healing and prevent infection.

At-Home Recovery

Following discharge from the hospital, the recovery process continues at home. Here's a general timeframe for what the patient can expect:

1. Within a week or two of returning home, the patient may be able to resume light activities.

2. Refraining from heavy lifting or vigorous activities for six weeks is crucial to facilitate adequate healing. 

3. Following this period, blood tests will likely be required to evaluate the remaining kidney function.

4. The doctor will provide instructions on the frequency of these tests.

First Follow-Up Appointment  

Regular monitoring of renal function is crucial for individuals with only one kidney following a nephrectomy. Typically, 4 to 6 weeks after discharge, the urology team will schedule an initial follow-up appointment. 

The frequency of subsequent follow-up visits depends on the stage of the patient's cancer at the time of surgery:

1. If the patient has early-stage kidney cancer, yearly follow-up appointments are common for the first few years after treatment.

2. For patients with later-stage kidney cancer, doctors may recommend a more intensive monitoring schedule. These follow-up visits may occur every 3-6 months during the initial three years after surgery.

Like any major surgery, nephrectomy carries some potential complications, although they're uncommon. These include:

1. General surgical risks like blood loss, heart attack, stroke, and allergic reactions to anaesthesia or medications

2. Blood clots, particularly in the legs, can travel to the lungs, called pulmonary embolism

3. Breathing problems

4. Infections can occur at the incision site

5. Development of a hernia or bulging of organs through the incision

When to consult a doctor? 

Post-nephrectomy recovery at home requires observation for signs needing a doctor's attention. These situations include:

1. Changes in urination, such as frequent urination or alterations in urine colour

2. High blood pressure

3. Nausea or vomiting

4. Brain fog, causing difficulty in concentrating

Risks of Delaying Kidney Operation 

Delaying a kidney operation can present various challenges, with potential complications. Below are some of the possible conditions that might arise due to delaying kidney operation.

1. Renal failure

2. Local tumour expansion leading to heightened discomfort

3. Cancer metastasis to the lungs, liver, and bones

The kidney operation cost in India can vary widely depending on several factors. Generally, it starts at ₹1,80,000 and can go up to ₹5,00,000. The average price of the procedure is ₹4,00,000.

Note: These prices are approximate. Talk to HexaHealth consultants for an updated price. 

1. Consultation Fee: The initial meeting with the urologist will discuss your health concerns and the suitability of a nephrectomy.

2. Type of Nephrectomy: The complexity of the surgery plays a major role in cost. A partial nephrectomy is typically less expensive than a radical nephrectomy (removing the whole kidney) and surrounding tissue.

3. Hospital Choice: Opting for a high-end, well-equipped hospital will likely cost more than a surgical centre with lower overhead costs.

4. Room Selection: Choosing a private room for post-operative recovery will be more expensive than a shared room. 

5. Location: Surgeons and hospitals in areas with a higher cost of living might charge more for the procedure.

Nephrectomy can be life-saving for individuals with severe kidney disease or cancer. The surgical approach is individualised and can help prevent severe complications such as renal failure, which can be life-threatening.  

A kidney operation requires the expertise of a highly qualified urologist. HexaHealth can connect you to these experts. We will assist you throughout the treatment process.  Get in touch to book your free consultation!