A nephrectomy is a surgical procedure in which tissue from a kidney is removed. Another situation in which a kidney may be removed is living kidney donation; a healthy person can live with just one kidney.
In the case of kidney cancer, the operation is carried out under general anaesthesia and, depending on the findings, may be open or minimally invasive.
When is a nephrectomy indicated?
In a radical nephrectomy, the entire kidney is surgically removed. The term ‘radical’ here refers to the complete removal of the kidney.
Another reason is the removal of a healthy kidney for a living kidney donation. A healthy person can live with just one kidney. The removed organ is intended for a kidney transplant in the recipient.
In the case of a tumour, a complete nephrectomy is not always necessary. In a partial nephrectomy, only the part containing the tumour is removed, whilst the remaining kidney tissue is preserved. The organ-preserving removal of a kidney tumour thus differs from a complete nephrectomy.
What investigations are required before the operation?
Before a nephrectomy for cancer, the extent of the tumour is assessed. A computed tomography (CT) scan of the abdomen and pelvis is used to determine the stage of the disease and to plan the operation. The findings also help determine whether a partial removal is possible.
A kidney biopsy is not required for all patients prior to the planned surgical removal of the tumour. This involves taking a sample of kidney tissue for examination. Whether the tissue sample is necessary depends on the clinical situation and the planned treatment.
Before the procedure, the surgical team requires details of any existing medical conditions and any anticoagulants being taken. This also includes any known kidney disease. This information is important for clinical planning, as it can influence the risk of complications.
How is a laparoscopic nephrectomy performed?
A nephrectomy for kidney cancer is carried out under general anaesthesia. The procedure can be performed either via open surgery or using a minimally invasive technique. With the minimally invasive procedure, only small incisions are required. Laparoscopic nephrectomy is a form of this keyhole surgery.
- General anaesthesia is administered.
- The surgeon creates an open or laparoscopic access route.
- The kidney tissue is removed as planned.
- Inpatient monitoring begins after the operation.
Laparoscopic surgery may be robot-assisted. In this case, the operating doctor controls the instruments. The technical system does not perform any surgical steps independently.
The duration of the operation depends on the technique used. In a study on laparoscopic living-donor nephrectomy, the procedure lasted around 181, 233 or 242 minutes, depending on the technique used. These are study figures for this specific type of nephrectomy, not a fixed duration.
Following kidney surgery for cancer, the hospital stay can range from a few days to over a week. The length of the post-operative recovery in hospital depends on the individual’s progress.
What complications can occur?
A nephrectomy may be associated with surgical complications. Wound infections and post-operative bleeding are particularly commonly reported.
Possible problems following the operation include:
- Wound healing: An infection of the surgical wound is possible.
- Bleeding: Post-operative bleeding may occur.
- New symptoms: These should be assessed by a doctor promptly between follow-up appointments.
In a US study of living kidney donations, 7.9% of donors experienced complications related to the operation.
How is kidney function monitored after the operation?
Following the complete removal of a tumour-affected kidney, the kidney function of the remaining organ must be monitored. This may involve blood pressure measurements as well as blood and urine tests.
Oncological follow-up care is tailored to the individual’s findings. If new symptoms arise between scheduled appointments, patients should seek medical advice and not wait until their next check-up.
What alternatives and chances of recovery are there for a tumour?
| Procedures | Who is it suitable for? | Classification |
|---|---|---|
| Total nephrectomy | In the case of a living kidney donation | The entire kidney is removed. |
| Cold or heat treatment | In the case of a small tumour, when surgery is not possible due to serious underlying conditions | These procedures are not equivalent to surgery. |
In the case of renal cell carcinoma, a cure is possible if the tumour can be completely removed and there is no evidence of metastases. However, this does not constitute a guarantee; the stage of the disease and the individual oncological findings are decisive.
What does health insurance cover in the case of a living kidney donation?
In the case of a living kidney donation, the recipient’s health insurance covers, amongst other things, the costs of pre-operative examinations and the hospital stay. Coverage of these costs should be clarified with the relevant insurance providers before the planned procedure.
Which doctors perform a nephrectomy?
In cases of kidney cancer, urology is one of the specialist fields involved in treatment; a urologist may therefore be involved in the treatment.
An important indicator of quality is experience with the intended procedure, whether open, laparoscopic or robot-assisted.
The following questions are suitable for the initial consultation at a urology centre:
- Can part of the kidney be preserved in my case?
- Why is open or minimally invasive surgery recommended?
- How much experience do you have with the planned surgical technique?
- How will the function of the remaining kidney be monitored after the procedure?
You can find specialists in nephrectomy at the end of this text.
Frequently asked questions about nephrectomy
What is a partial or radical nephrectomy?
In a radical nephrectomy, the entire kidney is removed. In a partial nephrectomy, some kidney tissue is preserved.
Is a biopsy always necessary before a nephrectomy?
No, a biopsy of the kidney tumour is not required for all patients prior to the planned surgical removal. The decision as to whether a tissue sample is necessary is based on the test results and the planned treatment.
What does a robot-assisted nephrectomy involve?
In robot-assisted nephrectomy, the doctor guides the instruments via a technical system. The robot does not operate independently.
How long do you stay in hospital after a nephrectomy?
Following kidney surgery for cancer, the hospital stay can last from a few days to over a week. The actual duration depends on how the operation goes and the recovery process following the procedure.
Can a nephrectomy cure kidney cancer?
A cure is possible if the renal cell tumour can be completely removed and there are no signs of metastases. However, this does not guarantee success.
How is the remaining kidney monitored?
Following the complete removal of a tumour-affected kidney, blood pressure measurements as well as blood and urine tests may be carried out. This allows the function of the remaining kidney to be monitored.
