radical nephrectomy

What is involved in the radical nephrectomy procedure?


Radical nephrectomy is a surgical procedure involving the complete removal of an entire kidney, often recommended in specific cases to effectively address kidney tumours. This approach is particularly considered when the size of the tumour is substantial and poses a significant risk to the overall health and function of the affected kidney. Large tumours may compromise the structural integrity of the kidney, making partial removal less feasible and radical nephrectomy a more viable option to eradicate the cancerous growth. Additionally, the decision for radical nephrectomy may be influenced by the involvement of the renal vein or vena cava, major blood vessels connected to the kidney. When tumours extend into these vessels, a more extensive intervention is often necessary to ensure thorough removal and prevent the potential spread of cancer to other parts of the body.

Although this procedure is often performed in a minimally invasive fashion, in certain instances, open surgery may be deemed necessary during radical nephrectomy. While minimally invasive techniques are often preferred, the complexity of the tumour or anatomical considerations may warrant a switch to open surgery for better visualization and control. The occasional need for open surgery underscores the importance of individualized treatment plans, where the surgical approach is tailored to the specific characteristics of the tumour and the patient's overall health. Ultimately, radical nephrectomy is considered when deemed essential for the effective eradication of kidney tumours, especially in cases involving large tumour sizes, vascular involvement, and when open surgery is deemed necessary for optimal surgical outcomes.

Radical nephrectomy is considered for larger renal tumours.


radical nephrectomy main points

Key Points:

The objective of radical nephrectomy is to eliminate a kidney bearing a tumour. The procedure often employs a telescopic (keyhole) technique through multiple small incisions in the abdomen.

  • In certain cases, the procedure may include the removal of the adrenal gland and adjacent lymph nodes.

  • Enlargement of one of the keyhole incisions is often necessary to extract the kidney.

  • The procedure is generally well-tolerated, with an average hospital stay of approximately three days.

  • Recovery typically spans four to six weeks, although individual variations may extend the timeline.

  • In open cases, prolonged recovery may be expected, but extending up to two or three months.

  • In open cases, bulging of the abdomen beneath the scar is common, attributed to nerve damage affecting the abdominal wall muscles during the procedure.

  • After the removal of a kidney tumour, regular and long-term follow-up with scans is imperative for comprehensive monitoring and assessment.

surgery

What occurs on the day of the procedure?

A/Prof Homi Zargar will discuss the surgery once again to ensure your understanding and obtain your consent. An anaesthetist will meet with you to explore the options of a general or spinal anaesthetic and discuss post-procedure pain relief.

Details of the procedure:

  • The procedure is conducted under general anaesthesia, ensuring the patient remains asleep throughout.

  • Before the procedure, an antibiotic injection may be administered after checking for allergies.

  • Abdominal cavity inflation is achieved by injecting carbon dioxide gas using a specialized needle.

  • A telescope and operating instruments are inserted into the abdominal cavity through three or four small incisions.

  • The kidney and its surrounding fat are liberated using these instruments, and the kidney is extracted by enlarging one of the port incisions.

  • Wound closure involves the use of absorbable stitches or clips, typically disappearing within two to three weeks, and local anesthetic is injected into the wounds for pain relief.

  • A catheter is placed in the bladder to monitor urine output, removed once the patient is mobile.

  • In some cases, a drain may be inserted to the area where the kidney was removed to prevent fluid accumulation, and this is removed when drainage ceases.

  • The duration of the procedure ranges from one to three hours, depending on complexity.

  • On average, patients can expect to stay in the hospital for about three days.

After-Effects and Risks of the Procedure:

  • Pain or discomfort at the incision site: Almost all patients may experience this.

  • Shoulder tip pain due to irritation of your diaphragm by the carbon dioxide gas: Occurs in between 1 in 2 and 1 in 10 patients.

  • Temporary abdominal bloating (gaseous distension): Experienced by between 1 in 2 and 1 in 10 patients.

  • For open cases, bulging of the abdominal wall below the wound due to damage to the nerves supplying the muscles: Occurs in between 1 in 2 and 1 in 10 patients.

  • For open cases, infection, pain or hernia at the incision site requiring further treatment 1 in 33 patients (3%)

  • Bleeding, infection, pain, or hernia at the incision site requiring further treatment: Affects 1 in 33 patients (3%).

  • Recognized (or unrecognized) injury to organs/blood vessels requiring conversion to open surgery (or deferred open surgery): Occurs in between 1 in 10 and 1 in 50 patients.

  • Bleeding requiring transfusion or conversion to open surgery: Affects between 1 in 10 and 1 in 250 patients.

  • Entry into your lung cavity requiring insertion of a temporary drainage tube: Happens in between 1 in 50 and 1 in 250 patients.

  • Anaesthetic or cardiovascular problems possibly requiring intensive care (including chest infection, pulmonary embolus, stroke, deep vein thrombosis, heart attack, and death): Occurs in between 1 in 50 and 1 in 250 patients; individual risk can be estimated by your anaesthetist.

  • Involvement or injury to nearby local structures (blood vessels, spleen, liver, lung, pancreas & bowel) requiring more extensive surgery: Happens in between 1 in 50 and 1 in 250 patients.

  • The abnormality in the kidney may turn out not to be cancer: Occurs in between 1 in 50 and 1 in 250 patients.

  • Dialysis may be required to stabilize your kidney function if your other kidney does not function well: Affects between 1 in 50 and 1 in 250 patients.