Radical Nephrectomy

Radical nephrectomy is a surgical procedure performed to remove an entire kidney. If required, additional structures such as the adrenal gland (located on top of a kidney) or lymph nodes present around the kidney are also removed along with the kidney. 

In some cases, only the diseased part of the kidney needs to be removed, leaving the rest of the healthy kidney intact. This procedure is known as partial nephrectomy.

People going through the following conditions may require a radical nephrectomy: 

1. Kidney Infection: Kidneys also form a part of the urinary tract along with the ureters, urethra, and bladder. If any of these parts are exposed to bacteria, it can cause a urinary tract infection (UTI), even putting the kidneys at risk. In such cases, the affected kidney may need to be surgically removed. 
2. Kidney Cancer: When the cells of a kidney become malignant or cancerous, their uncontrolled growth can cause a tumour and a swollen kidney. So, surgery is vital to prolong the patient’s life and prevent the spread of cancer to other body organs. 
3. Chronic Kidney Disease: It is a condition when the kidney stops working for more than three months. The most common reason for chronic kidney disease is high blood pressure and diabetes. So, when the kidney fails to remove toxins from the body, high levels of waste start building up in the blood, resulting in extreme sickness for the patient. This is why surgery is needed to remove the kidney.
4. Traumatic Kidney Injury: Even though the back muscles and the rib cage protect the kidneys, severe injuries can cause disabling damage. Mainly two types of injuries can lead to a traumatic kidney injury: 
   1. Blunt Trauma: Injury due to a physical attack or a forceful impact by an external object without piercing the skin.
   2. Penetrating Trauma: When an external object pierces the skin, creating a wound inside. 
5. Kidney Donation: Another reason for a radical nephrectomy is kidney donation. In the surgery, the patient’s damaged kidney is removed and replaced by a healthy one. In many cases, people donate a kidney to someone in need.  

If one or both kidneys fail to perform their function, high levels of toxins and excess fluid may build up in the blood, causing weakness, shortness of breath, or even abnormal heart rhythms. This may lead to severe health risks if it remains untreated. Radical nephrectomy removes the damaged kidney so the patient may lead a fulfilling life with one healthy kidney. 

In the case of a renal tumour, delaying radical nephrectomy may adversely affect the treatment outcomes if delayed for more than three months. 

Radical nephrectomy is the removal of the entire kidney from the body. A urologist or a urology surgeon usually performs this surgery. Along with the kidney, a surgeon may remove the fatty tissues surrounding the kidney and a small portion of the tube that connects the kidney to the bladder. If a renal tumour also affects the adrenal gland (positioned on top of the kidney), it may also need to be removed. 

Radical nephrectomy is performed under the following procedures: 

1. Open Nephrectomy: In this procedure, a urology surgeon makes an incision on the side of the patient’s body. This type of surgery allows the surgeon to perform the procedure safely, which still cannot be performed using less invasive methods in many cases. 
2. Laparoscopic Nephrectomy: A surgeon makes a few small incisions over the abdomen of the patient’s body to insert a tube-like device inside a person’s body. The device is equipped with a video camera and small surgical tools. 
3. Robot-Assisted Laparoscopic Surgery: This procedure is a variation of laparoscopic surgery, in which a surgeon performs the surgical procedure with the help of a robotic system. The robotic system can perform complex motions effectively, as a surgeon’s hand would perform in open surgery. The tools used in this method require relatively smaller incisions and provide better 3-D images. 

1. The healthcare providers take blood samples of the patient to identify the blood type in case a transfusion is needed. 
2. The doctor briefly explains the surgical procedure step-by-step, along with the duration and estimated costs.
3. The patient must inform the doctor about all the medicines, including the non-prescriptive medicines such as Aspirin, he/she has been taking. 
4. The doctor provides instructions regarding which medicines to continue or avoid (such as blood thinners).
5. He/she also instructs the patient regarding fasting a day before the surgery.
6. The doctor advises a pre-anaesthesia checkup and other diagnostic tests based on the patient’s medical history.
7. It is beneficial to quit smoking (if a smoker) to increase the chances of a successful recovery after the surgery.

1. The patient first signs all the consent forms after checking in at the hospital
2. He/she is made to change into a hospital gown
3. The healthcare providers monitor the patient's vitals to check blood oxygen level, heart rate and blood pressure. Then they transfer him/her to the OT room
4. If required, the surgical site might be shaved

1. An anaesthesiologist induces general anaesthesia so that the patient remains asleep and doesn’t feel any pain during the surgery
2. An intravenous (IV) line is started in the arm and hands to supply IV fluids and medications to the body
3. The healthcare providers may also place a urinary catheter (a small tube to drain urine from the bladder)

In case of open surgery,

The patient will be placed on his/her side to make an 8-12 inches long incision just below the ribs to remove the damaged kidney

In the case of laparoscopic surgery, 

1. The surgeon makes three to four small incisions not longer than an inch in the patient’s belly and side
2. The procedure is performed with the help of microscopic probes and a camera
3. Towards the end of the procedure, the surgeon makes a cut of about 4 inches to remove the swollen or damaged kidney from the body
4. After the surgery is complete, he/she closes the incisions with the help of sutures and stitches

1. A healthcare provider shifts the patient to the recovery room for monitoring of the vitals and the after-effect of anaesthesia
2. Radical nephrectomy is an inpatient surgery that requires the patient to stay in the hospital till his/her condition is stable
3. A catheter might be used to drain urine from the bladder for a short period
4. Pain and soreness around the stitches are not uncommon after the surgery
5. The healthcare providers give pain-relieving medicines to ease the pain 
6. Shortly after the surgery, the patient is asked to leave the bed and walk to promote healing and avoid any risks such as pneumonia
7. They also monitor the condition of the patient to detect any other signs of complications
8. Once the patient’s condition improves, doctors arrange for home care and provide follow-up instructions

At Home

1. The patient must keep the stitches clean and covered
2. Proper bathing instructions must be followed to avoid the water directly hitting the wound
3. Certain dietary restrictions need to be followed as suggested by the doctor
4. In the case of a newly transplanted kidney, the patient needs to take immunosuppressants or anti-rejection medicines to prevent the immune system from attacking and rejecting a newly transplanted kidney

Recovery

1. It may take six weeks for the patient to recover fully
2. After the surgery, the patient must include exercises in his/her routine for physical and mental well-being.

The patients need to visit the doctor 4-6 weeks after the surgery. During the follow-up, the doctor monitors the function of the remaining kidney by physical examination and measurement of serum creatinine and haemoglobin. 

The patient must visit the doctor every year for a checkup of the remaining kidney. Every few years, the patient must also test the kidney functions to measure the creatinine and glomerular filtration rate (GMR). The doctor will examine blood pressure and urine in the tests. If any presence of protein is detected in the urine, it may be because of some defect in the remaining kidney. 

After the surgery, the patient must take extra precautions. If any of the following symptoms are observed, he/she must call the doctor immediately: 

1. Fever over 100°F
2. Drainage from the incisions
3. Increased pain around the incision site

Risks and Complications Involved in a Radical Nephrectomy

Radical nephrectomy bears the risks of the following complications: 

1. Blood clotting
2. Drainage from the surgical site
3. Post-surgery infection
4. Pneumonia
5. Allergic reaction from anaesthesia (in rare cases)