What is an open nephrectomy?
Open nephrectomy is an operation performed through an incision on the front or the side of the abdomen to remove a kidney. Dr Nathan will usually remove a kidney using key-hole (laparoscopic) surgery due to quicker post-operative recovery, However, in complex cases open nephrectomy may be recommended if key-hole surgery is not thought to be feasible.
Why do I need a nephrectomy?
There are several reasons for removing a kidney:
- The kidney may not be working or only partially working; if left in place it can be a source of infection or pain.
- Infection may have damaged the kidney so that it requires removal.
- A cancer arising in the kidney may have been diagnosed; the usual treatment for this is to remove the kidney.
If a cancer has been found in the kidney, it is sometimes necessary to remove the adrenal gland, which lies on top of the kidney, at the same time.
In some kidney cancers there is a high risk of cancer recurrence in the ureter (tube which carries urine from the kidney to the bladder). If this has been found then the ureter will also have to be removed which would mean a small incision lower down on your abdominal wall as well as the other small incisions.
The reason for removing your kidney will be discussed with you.
What are the alternatives?
Your surgeon will have discussed these alternatives with you, if they apply to your case.
- Laparoscopic nephrectomy (removal of the kidney by key hole surgery)
- A partial nephrectomy (removal of part of the kidney)
- No operation
- Surveillance of the kidney
What should I expect before the procedure?
You will usually be admitted to hospital on the same day as your surgery. Immediately before the operation, the anaesthetist may give you a pre-medication, which will make you dry-mouthed and pleasantly sleepy.
You will need to wear anti-thrombosis stockings during your hospital stay. These help prevent blood clots forming in the veins of your legs during and after surgery.
Please tell your surgeon (before your surgery) if you have any of the following:
- An artificial heart valve.
- A coronary artery stent.
- A heart pacemaker or defibrillator.
- An artificial joint.
- An artificial blood-vessel graft.
- A neurosurgical shunt.
- Any other implanted foreign body.
- A regular prescription for a blood thinner e.g. Warfarin, Coumadin Xarelto®, Pradaxa®, Clopidogrel (Plavix®), Brilinta®, or Aspirin.
- Previous or current infection with an antibiotic resistant organism such as MRSA, VRE, etc.
What happens during the procedure?
A full general anaesthetic is normally used and you will be asleep throughout the procedure. You will usually be given an injection of antibiotics before the procedure, after you have been checked for any allergies. The anaesthetist may also use an epidural or spinal anaesthetic to reduce the level of pain afterwards. The surgeon will normally remove your kidney (pictured with a yellowish tumour) through an incision in your tummy. Sometimes, the incision is made in the side (loin) or extended into the chest area. A catheter is usually put into the bladder to monitor urine output with a drainage tube down to where the kidney was removed.
Sometimes, it may be necessary to insert a tube through your nose, especially if the operation was particularly difficult, to prevent bloating of your stomach.
Potential side effects and complications
All procedures have the potential for side effects. Although these complications are well recognised, the majority of patients do not have problems after a procedure.
Risks of the anaesthetic need be discussed with the anaesthetist who will be looking after you during the operation, and who will visit you beforehand.
There are specific risks with this surgical procedure, and these will be discussed with you before your procedure. As a guide to complement that one-on-one discussion with your surgeon, these include:
Common (greater than 1 in 10)
- Temporary bloating of your tummy.
- Bulging of the wound due to damage to the nerves serving the abdominal wall muscles.
Occasional (between 1 in 10 and 1 in 50)
- Bleeding, infection, pain or hernia of the incision needing further treatment.
- Entry into the lung cavity needing insertion of a temporary drainage tube
- Need of further therapy for cancer.
Rare (less than 1 in 50)
- Anaesthetic or cardiovascular problems possibly requiring intensive care admission (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack and death).
- Involvement or injury to nearby local structures (blood vessels, spleen, liver, lung, pancreas and bowel) needing more extensive surgery.
- The pathology of the kidney may subsequently be shown not to be cancer.
- Dialysis may be needed to improve your kidney function if your other kidney functions poorly.
After the operation
You may be monitored initially on a high dependency unit or ICU. You will have intravenous fluids (a drip) going into an arm vein or jugular vein in your neck. This will remain in place until you are drinking normally. You can start having some oral fluids immediately after the operation, and the drip can usually be removed after a few days. Food can usually be started once the bowel function returns usually 2-3 days after surgery.
A urinary catheter) will be inserted whilst you are under anaesthetic, which is usually removed once you are mobile. Occasionally during the operation a wound drain is placed at the site of the kidney to drain away any blood. This will be removed when there is little or no drainage from it (usually the following day).
You may feel nauseated for 24 hours following the operation but medication can be administered to control this.
You may have and epidural or patient controlled anaesthesia (PCA) to alleviate any pain or discomfort. It is important that your pain is sufficiently controlled so that it does not affect your breathing or delay mobilisation. The physiotherapist may see you to discuss breathing exercises and help with mobilisation.
You will be encouraged to sit out of bed for the day following the operation and to walk a short distance. On the second day after the operation you should be able to be out of bed most of the day and walking longer distances.
Once the catheter is removed and you are passing urine satisfactorily and mobilising well, you will be discharged home – usually 5-7 days after your surgery.
It is sensible to avoid driving for 4 -6 weeks and heavy lifting for 6-8 weeks after the operation. Exercise should be increased gradually. Start with short walks and gentle exercise. Eat a healthy diet with plenty of fluids. Fresh fruit and vegetables are important to keep your bowels regular.
Your wound will take at least six weeks to heal and it may be up to two months before you fully recover from the surgery. You may return to work when you are comfortable enough and your surgeon or GP is satisfied with your progress.
It is advisable that you continue to wear your elasticated stockings for 14 days after you get home. You may have persistent twinges of discomfort in your wound, which can go on for several months. After surgery through the loin, the abdomen below the scar often bulges as a result of nerve damage. This is not a hernia and can be helped by strengthening up the muscles with exercises.
This information is intended as a general educational guide and may not apply to your situation. You must not rely on this information as an alternative to consultation with your urologist or other health professional.
Not all potential complications are listed, and you must talk to your urologist about the complications specific to your situation.