You'll receive general anesthesia before surgery and be unconscious during the entire procedure. You'll likely have a urinary catheter, a tube used to drain urine from your bladder.
During the procedure
The nephrectomy procedure varies, depending on how the surgery is performed and how much of the kidney is removed. Variations include:
- Open surgery. In an open nephrectomy, the surgeon makes an incision about 10 to 20 inches (25 to 50 centimeters) long in either your side or your abdomen — typically between the lower ribs on the side of the affected kidney. The surgeon may need to remove a lower rib to gain better access to the kidney.
- Laparoscopic surgery. In this minimally invasive procedure, the surgeon makes a few small incisions in your abdomen to insert wand-like devices equipped with video cameras and small surgical tools. The surgeon makes a somewhat larger opening if your entire kidney needs to be removed.
- Robot-assisted laparoscopic surgery. The surgeon may use a robotic system to perform a laparoscopic nephrectomy. Robotic tools require very small incisions, provide better imaging of the procedure and enable precise removal of diseased tissue. The surgeon controls the surgical instruments from a remote console a short distance from the operating table. The assisting surgical team inserts the instruments through the abdominal incisions and attaches the instruments to the system's robotic arms.
- Radical nephrectomy. In a radical nephrectomy, the surgeon removes the whole kidney, the fatty tissues surrounding the kidney and a portion of the tube connecting the kidney to the bladder (ureter). The surgeon may remove the adrenal gland that sits atop the kidney if a tumor is close to or involves the adrenal gland.
- Partial nephrectomy. In a partial nephrectomy — also called kidney-sparing surgery — the surgeon removes a cancerous tumor or diseased tissue and leaves in as much healthy kidney tissue as possible.
Robotic partial nephrectomy, laparoscopic partial nephrectomy and traditional open surgery yield similar long-term outcomes. However, the much smaller incisions in robotic and laparoscopic surgery usually mean you'll have less postoperative pain and blood loss and a faster return to your normal activities.
After the procedure
Recovery time and the length of your hospital stay depend on your overall health and the type of nephrectomy performed.
Depending in part on your ability to get out of bed and the type of procedure performed, the urinary catheter will likely be removed sometime during the first 24 to 48 hours after the surgery.
Expect to receive instructions before leaving the hospital about restrictions to your diet and activity level. In general, you'll likely be encouraged to begin light, everyday activities as soon as you are able to. You'll need to avoid strenuous activity or exercise for several weeks.
May 23, 2012
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