Nephrectomy is the surgical removal of a
kidney.
History
The first
successful nephrectomy was performed by the German surgeon Gustav Simon on August 2nd, 1869 in
Heidelberg
. Simon practiced the operation beforehand in
animal experiments. He proved that one healthy kidney can be
sufficient for urine excretion in humans.
Indications
There are various indications for this procedure, such as
renal cell carcinoma, a non-functioning
kidney (which may cause
high blood
pressure) and a congenitally small kidney (in which the kidney
is swelling, causing it to press on nerves which can cause pain in
unrelated areas such as the back). Nephrectomy for renal cell
carcinoma is rapidly being modified to allow partial removal of the
kidney. Nephrectomy is also performed for the purpose of living
donor kidney transplantation.
Procedure
The surgery is performed with the patient under
general anesthesia. The surgeon makes an
incision in the side of the
abdomen to reach
the kidney. Depending on circumstances, the incision can also be
made
midline. The
ureter and blood vessels are disconnected, and the
kidney is then removed. The surgery can be done as
open surgery, with one incision, or as a
laparoscopic procedure, with
three or four small cuts in the abdominal and flank area. Recently,
this procedure is performed through a single incision in the
patient's belly-button. This advanced technique is called as
Single Port Access
Surgery.
In January 2009, a woman who had previously had a hysterectomy was
able to donate a kidney and have it removed through her vagina.
The
operation took place at Johns Hopkins Medical Center
. This is the first time a healthy kidney has
been removed via this method, though it has been done in the past
for nephrectomies carried out due to pathology. Removing organs
through orifices prevents some of the pain of an incision and the
need for a cosmetically unappealing larger scar. Any advance which
leads to a decrease in pain and scarring has the potential to boost
donor numbers. This operation also has taken place at the Cleveland
Clinic.
For some illnesses, there are alternatives today that do not
require the extraction of a kidney. Such alternatives include
renal embolization for those who
are poor candidates for surgery, or partial nephrectomy if
possible.
More rarely, renal cell cancers can involved adjacent organs, yet
may be safely and completely removed surgical vie open or
laparoscopic techniques.
After Care
Pain medication is often given to
the patient after the surgery because of pain at the site of the
incision. An
IV with fluids is administered.
Electrolyte balance and fluids are
carefully monitored, because these are the functions of the
kidneys. It is possible that the remaining kidney does not take
over all functionality. A patient has to stay in the hospital
between 2 and 7 days depending on the procedure and
complications.
References
- http://news.bbc.co.uk/1/hi/health/7867837.stm Donor kidney
removed via vagina
- http://www.ncbi.nlm.nih.gov/pubmed/10037359 Complete renal
embolization as an alternative to nephrectomy
- Crotty KL, Macaluso JN: Partial Colectomy Required for
Resection of Renal Cell Carcinoma: A Case Report and Review of
Treatment Options for Locally Advanced Disease. Journal of the
Louisiana State Medical Society, Vol 152, 119-123, March 2000
See also
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