Nephrectomy (partial or total) is the removal of the kidney. Our kidneys, two in number, serve as a blood purification station for the body, ejecting waste in the form of urine. One of the kidneys can be removed for tumors, or for organ donation. You can live very well with just one kidney.

Nephrectomy is the surgical operation of the total or partial removal of one of the waist. 

The role of the kidneys

The kidneys are essential for the proper functioning of the body. Indeed, they play a role of waste filter. They constantly receive blood and extract unwanted elements from it, which will be eliminated in the form of urine. They also produce a hormone, erythropoietin, which is used to make red blood cells. Their activity also includes the regulation of blood pressure, and the production of vitamin D to strengthen bones.

They are located in the lower back, on either side of the spine. 

The kidneys are made up of blood vessels, the renal parenchyma (which secretes urine), and tubes for passing urine out of the body.

Total or partial?

Nephrectomies can be of different types, depending on the number and size of the kidney harvest.

• Nephrectomies totals remove an entire kidney. If the surrounding lymph nodes are removed from the kidney, it is a total nephrectomy. expanded, in the case of kidney cancer that has developed.
• Nephrectomies partial, for example to remove a tumor or to treat an infection, make it possible to preserve the kidney. Part of the renal parenchyma is usually removed as well as the corresponding excretory pathway.
• Nephrectomies bilateral (or binephrectomies) are the removal of both kidneys, in the most severe cases (the patient is then kept hospitalized using artificial kidneys).

  This type of nephrectomy is used on organ donors who have died of brain death. In this case, the kidneys can be transplanted to a compatible patient. This type of donation saves thousands of kidney failure patients every year.

Preparing for a nephrectomy

As before any operation, it is recommended not to smoke or drink in the preceding days. A pre-anesthetic examination will be performed.

Average hospitalization

Nephrectomy requires a heavy operation and rest for the patient / donor. The duration of hospitalization is therefore between 4 and 15 days depending on the patient, sometimes up to 4 weeks for rare cases (such as tumors). The convalescence then lasts nearly 3 weeks.

The review in detail

The operation is under general anesthesia, and lasts an average of two hours (variable time). There are different methods depending on the objective.

• Coelioscopie

  In the case of a partial nephrectomy, such as the removal of a kidney tumor, the surgeon inserts instruments without “opening” the patient, using fine incisions on the side of the hip. This makes it possible to limit the size of the scars and therefore the risks.

• Laparotomy

  If the kidney has to be completely removed (total nephrectomy), then the surgeon performs a laparotomy: using a scalpel he makes an incision large enough on the side of the hip to be able to remove the kidney involved in the operation. .

• Robotic assistance

  It is a new practice, still not very widespread but effective: the robot-assisted operation. The surgeon controls the robot remotely, which in certain conditions makes it possible not to move or improve the precision of the operation.

Depending on the purpose of the operation, the surgeon therefore removes the kidney, or part of it, then “closes” the opening he made, using sutures.

The patient is then bedridden, sometimes with the legs elevated to promote blood circulation.

Risks during the operation

Any surgical operation presents risks: bleeding, infections, or poor healing.

Post-operative complications

A nephrectomy is a heavy operation, often followed by complications. We note among others:

• Haemorrhages
• Urinary fistulas
• Red scars

In any case, discuss it before and after the operation with your urologist.

After the operation

In the days and weeks that follow, we generally advise against too much physical activity and effort.

An anti-coagulant treatment is taken to promote healing.

Organ donation

This is the most “famous” reason for nephrectomy, at least in popular culture. Kidney donation is possible from a living donor, often from close family to optimize the compatibility of the transplant. You can live with just one kidney, using regular dialysis and adapting your lifestyle.

These donations are sometimes made from organ donors who have died of brain death (the kidneys are therefore still in good condition).

Cancer, tumors and serious infections of the kidney

Kidney cancer is the other major cause of nephrectomies. If the tumors are small, it is possible to remove them without removing the entire kidney (partial nephrectomy). On the other hand, a tumor which will have spread to the whole kidney causes its total ablation.