(Surgical Removal of a Kidney)
Dear patient, if you are reading this, then you were likely diagnosed with a kidney abnormality such as a solid tumor, a suspicious cyst or another condition that warrants the removal of a kidney. This type of surgery is called a “radical nephrectomy.”
There are various methods of doing this procedure. In the past, the only approach was to make a long cut on the side of the belly to remove the kidney. Then in the 1990’s, we began doing these procedures laparoscopically, using small cuts in the belly with “chopstick” type of instruments and a long telescope-like camera. In the early 2000’s a new instrument came into play called the DaVinci robot that allows for wrist-like movements of the thin instruments that are placed through small cuts in the belly and are controlled by the surgeon with joysticks.
The robotic surgery allows for a high definition 3-D view of the inside of the belly improving precision of the operation. Currently, Broward Urology Center offers both laparoscopic and robotic approaches in removing a diseased kidney. Drs. Chenven and Gorbatiy spent an extra 1-2 years, after their residency training, in “exclusive” fellowships in minimally invasive surgery. They have operated on several hundred patients with these types of techniques over the past two decades.
This guide is intended to explain how the procedure is done, how to prepare for it and what to expect after the procedure.
What are the Kidneys?
The kidneys are a pair of organs located towards the back of the belly (flank area). Each is about the size of a fist. The kidneys are essential organs, which filter the toxins from the blood and balance the water and salts in the body. As the kidneys filter blood, they create urine, which collects in a funnel-shaped structure called the “pelvis of the kidney” and leaves the kidneys down tubes called “ureters" to finally reach the bladder. The kidneys are essential to life.
What are the Reasons to Remove a Kidney?
Surgical removal of a kidney is a serious procedure, thus, the reasons to have that done are either life threatening or are causing people significant discomfort.
The most common reason to remove a kidney would be a large kidney tumor. See below for more information. However, there are non-cancer reasons as well that include a poorly functioning kidney, chronically infected kidney, or a kidney that has been damaged badly in a physical trauma.
What is a Kidney Tumor?
A kidney tumor, also referred to as a “mass” or “lesion” is simply a solid growth in the kidney. There are growths in the kidney that may be full of liquid (resembling a pimple) that are referred to as kidney cysts. The majority of kidney cysts are benign and in most cases do not require any intervention; however, solid tumors typically need to be addressed. Some cysts may have solid elements and thus be suspicious for cancer so these may need to be addressed as well.
Most kidney tumors are malignant, which means they are a kidney cancer. On average, 80% of tumors about 1.5 inches in size are malignant while 20% of those are benign (non-cancerous) tumors.
Depending on the size and location, the tumor may be removed while sparing the rest of the kidney ( partial nephrectomy ) or it may require a total kidney removal.
How is the Radical Nephrectomy Surgery Done?
A nephrectomy means that a surgeon removes the entire kidney. This surgery may be done these days through small holes in the belly (laparoscopically) as well as with the assistance of a hand (“hand-assisted”) or even the DaVinci “robot” machine that allows for the surgeon to control small laparoscopic instruments with joysticks. The surgeon must control the arms of the robot and the laparoscopic instruments attached to them. The robot does NOT function independently on its own. In rare cases, the surgery may need to be done with a traditional, large open incision.
The steps of the operation:
How Long Does the Operation Take?
The operation takes 2-3 hours to complete. In cases where patients are obese, had previous belly surgeries, the tumor is large, the anatomy is difficult or there are multiple tumors, the procedure may take longer.
What is the Recovery After the Operation?
Most patients stay in the hospital for 1 to 2 days. The goal is to get you out of the hospital as fast as possible, when you are safe to go, so that you may avoid catching any hospital related infections. The most important step to a speedy recovery is to move as much as you can. The more you move, the faster the bowels wake up, and the less likely you will get blood clots in the legs.
The following is the typical hospital course:
Immediately after surgery
Day #1 after surgery
❏ Passed gas
❏ Pain is well controlled with pills
❏ There are no signs of an infection
❏ Blood pressure and blood tests are good
When the doctor deems you to be safe to go home, your nurse will remove the IV from your arm and provide you with discharge instructions as well as prescriptions which typically include a pain medication and a stool softener.
Most patients report that they feel like they are back to “normal” at about 2-3 weeks after the operation. Typically, patients feel that their belly is a bit swollen for a few weeks. The incisions may have some bruising. Male patients may feel some testicular discomfort on the same side of the kidney that was operated on. Some patients may feel like their bowels are not moving normally for a little while after surgery and many report feeling more tired for a few weeks.
What are the Risks of the Radical Nephrectomy Surgery?
What are the Alternative Treatment Options?
The treatment options for solid kidney tumors besides a radical nephrectomy (starting with the least aggressive to the most aggressive option) include:
Active Surveillance - close monitoring with repeat imaging of the kidneys over time; Surveillance may be done with or without a diagnostic biopsy. This is usually reserved for very small kidney masses or for patients who are too ill for surgery.
Kidney Tumor Embolization - certain benign tumors (like Angiomyolipomas) are treated with this procedure where the Interventional Radiologist is able to cut off the blood supply to the tumor.
Kidney Tumor Ablation - either through the back (percutaneously) or laparoscopically (small belly opening), a special needle is used to penetrate the tumor and either burn it or freeze it to death.
Partial Nephrectomy - surgery to cut a tumor out of the kidney while trying to preserve the rest of the normal kidney is reserved for smaller kidney tumors that are in a safe location.
Pre-Operative Instructions: Radical Nephrectomy
If you are currently awaiting a radical nephrectomy, it is essential for your own safety and for the success of your operation that you carefully read and observe these instructions.
Preparation Prior to Surgery
Ten (10) days before surgery please STOP taking any
If you are on Plavix (clopidogrel), Coumadin (warfarin) or any other prescribed blood thinner, make sure you mention this to the doctors so we could have a clear permission from your primary doctor or cardiologist to stop those medications safely prior to surgery.
Take your usual doses of heart, thyroid, and asthma medications on the morning of surgery with a tiny sip of water. If you are diabetic and take medication, do not take them on the morning of surgery. If you take insulin, only use half the normal dose on the morning of surgery.
Get Your Body Prepared for Surgery
In the days leading up to surgery, eat a healthy diet to help the body heal faster.
The Day of Your Procedure
Recovery at Home
We hope these instructions are useful to you. If there are any questions not covered by the instructions, please contact us at the above phone number. It has been a pleasure working with you to resolve your problem.