A nephrectomy is a surgery in which a kidney or part of a kidney is removed.
Parts of the Body Involved
[ Kidneys ]
How is the procedure performed ?
There are three basic types of kidney removal, including : -
simple nephrectomy, which involves removal of just the diseased kidney
radical nephrectomy, which involves removal of the kidney, the adrenal gland above the kidney, the surrounding fatty tissue, and the lymph nodes next to the kidney. Lymph nodes, sometimes called glands, are part of the immune system. This procedure is usually done when cancer of the kidney is present.
partial nephrectomy, which involves removing only part of one kidney. This is not usually attempted unless a person has only one kidney.
Reasons for Procedure
Kidney removal may be done because of : -
Birth defects
Injuries to the kidney
Infection
High blood pressure
Tumor
Chronic bleeding
Kidney donation for a transplant
Risk Factors for Complications During the Procedure
Risk factors from anesthesia include : -
Difficulty breathing
Reactions to the anesthesia
Risk factors from the surgery include : -
Infection
Bleeding
What to Expect ?
Prior to Procedure
If a transfusion is needed either before or after surgery, it's important that your blood samples are typed and cross-matched.
A catheter is inserted into the bladder.
In the days leading up to your procedure : -
Do not take aspirin or other anti-inflammatory drugs for one week before surgery, unless told otherwise by your doctor. You may also need to stop taking blood-thinning medications. Examples include clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid). Talk to your doctor.
Anesthesia
General anesthesia will be given. You will be asleep and will not feel pain during the procedure.
Description of the Procedure
Once the anesthesia takes effect, the surgeon makes an incision in the abdomen or side of the abdomen. A rib may need to be removed to access the kidney. The ureter (which carries urine from the kidney to the bladder) and blood vessels are cut. The kidney (or part of the kidney) is removed. The incision is then closed.
Kidneys, Ureters, and Renal Blood Vessels
Laparoscopic surgery may also be used for nephrectomy. Generally, this approach is reserved for tumors less than 10 cm in size. The surgeon inflates the abdominal cavity with gas(CO2) and makes several key-hole size incisions. Similar to the open approach, the ureter and blood vessels are cut. The kidney (or part of the kidney) is removed. A small incision is made to retrieve the kidney.
What is laparoscopic nephrectomy?
Laparoscopy : - also known as "keyhole surgery" - is a minimally invasive surgical procedure in which a special camera called a laparoscope is used to produce an inside view of the abdominal cavity. Surgeons use the laparoscope, which transmits a real-life picture of the internal organs to a video monitor, to guide them through surgical procedures. The laparoscope magnifies these images many times their actual size, providing surgeons with a superior view of the abdomen.
Laparoscopic nephrectomy : - is a minimally invasive procedure that uses a laparoscope to remove a kidney for donation. Laparoscopic kidney removal is considered minimally invasive because it only requires three or four small non-muscle-cutting incisions rather than one large muscle-cutting incision in the abdomen. (See below).
Laparoscopic Nephrectomy
Open Nephrectomy
Incision
Three half-inch incisions in the abdomen; one 2.5 to 3 inch incision low in the abdomen, in the bikini area. No muscle is cut during any of these incisions.
An 6 to 10 inch muscle cutting incision on the side of the abdomen; frequently requires removal of one rib
Length of hospital stay
1 to 2 days
3 to 5 days
Recovery
Less scarring after surgery
Less discomfort and decreased need for pain medication
Increased scarring after surgery
Greater need for pain medication
Return to normal activity
2 to 4 weeks
8 to 12 weeks
During the procedure, carbon dioxide is passed through one of the incisions into the abdominal cavity to lift the abdominal wall away from the organs below, creating more operating space to perform the surgery. The pencil-thin laparoscope and surgical instruments are then inserted through the other incisions.
At the end of the procedure, the kidney is removed through a 7 cm, non-muscle-cutting incision in the bikini area.
After Procedure
You are generally encouraged to move around and be cautiously active as symptoms allow. Avoid strenuous exercise or activities for approximately six weeks.
After the procedure, be sure to follow your doctor's instructions .
How Long Will It Take ?
The surgery will take between 3-4 hours.
Will It Hurt ?
Recovery from nephrectomy is usually painful, because of the location of the incision. The laparoscopic approach is significantly less painful.
Possible Complications
Risk factors from anesthesia include : -
Difficulty breathing
Reactions to the anesthesia
Risk factors from the surgery include : -
Infection
Bleeding
Damage to near-by organs
Average Hospital Stay
Typical hospital stay following nephrectomy is 2-7 days. The exact length depends on the type of surgery performed.
Postoperative Care
Intravenous fluids and pain medication are given following the surgery. Blood pressure, electrolytes, and fluid balance should all be carefully monitored. A urinary catheter is often required for a short time following surgery.
Outcome
Prognosis following nephrectomy is usually good, particularly if only one kidney or part of a kidney has been removed. If both kidneys are removed, hemodialysis or kidney transplantation is necessary.
Call Your Doctor If Any of the Following Occurs : -
Have a fever of over 100°F
Are in a great deal of pain
Suddenly become very weak
The incision site is leaking fluid or is bleeding
Are not able to urinate
The list of of Nephrology Hospitals in India is as follows : -
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