A nephrectomy is the surgical removal of a kidney, the organ that filters waste from the blood and produces urine. There are two kidneys, right and left. Each is about 4 inches to 5 inches long. They are located at the back of the abdomen, just below the diaphragm, behind the liver on the right, and the spleen on the left. A portion of each kidney is protected by the lowest one or two ribs and by the muscles that cover the back and side of the body. Depending on the reason for a nephrectomy, all or part of one kidney or both kidneys will be removed:
Partial nephrectomy – Part of one kidney is removed.
Simple nephrectomy – All of one kidney is removed.
Radical nephrectomy – All of one kidney is removed together with the neighboring adrenal gland (the adrenaline-producing gland that sits on top of the kidney) and neighboring lymph nodes.
Bilateral nephrectomy – Both kidneys are removed.
A nephrectomy can be done by conventional open surgery. For a simple nephrectomy, laparoscopic surgery is also available at a growing number of medical centers.
In a conventional open nephrectomy, the surgeon removes the kidney through a standard incision (surgical cut) between 8 and 12 inches long. When possible, this incision is made in the side of the body to allow the surgeon access to the kidney while only minimally disturbing the abdominal organs. However, depending on the reason for the nephrectomy and the health of the patient, an incision may be made in the front of the abdomen or in the back.
In the laparoscopic procedure, four small incisions are made in the wall of the abdomen. The doctor uses a laparoscope (a rod-shaped instrument with a camera for viewing inside the body) to guide the surgical instruments and to free the kidney. If the kidney is being removed for donation, one incision must be enlarged to between 6 and 9 centimeters so that the kidney can be removed in one piece. Usually, this larger incision is next to the navel or in women, along the bikini line in the lower abdomen.
Both conventional open nephrectomy and laparoscopic nephrectomy are done with the patient under general anesthesia, so that the patient is not awake during the procedure. Laparoscopic nephrectomy usually causes less pain during recovery than a conventional nephrectomy, and allows a quicker recovery and less-obvious scarring. However, laparoscopic nephrectomy takes a longer time under anesthesia than an open nephrectomy and requires a surgeon who is skilled in laparoscopy. A laparoscopic nephrectomy is not practical for people with significant scarring around the kidney or people who need a radical nephrectomy.