Definition

Kidney removal, or nephrectomy, is surgery to remove all or part of a kidney. It may involve:

• Part of one kidney removed (partial nephrectomy).
• All of one kidney removed (simple nephrectomy).
• Removal of one entire kidney, surrounding fat, and the adrenal gland (radical nephrectomy). In these cases, neighboring lymph nodes are sometimes removed.

Alternative Names

Nephrectomy; Simple nephrectomy; Radical nephrectomy; Open nephrectomy; Laparoscopic nephrectomy; Partial nephrectomy

Description

This surgery is done in the hospital while you are asleep and pain-free (general anesthesia). The procedure can take 3 or more hours.

Simple nephrectomy or open kidney removal:

• You will be lying on your side. Your surgeon will make an incision (cut) up to 12 inches or 30 centimeters (cm) long. This cut will be on your side, just below the ribs or right over the lowest ribs.
• Muscle, fat, and tissue are cut and moved. Your surgeon may need to remove a rib to do the procedure.
• The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed.
• Sometimes, just a part of the kidney may be removed (partial nephrectomy).
• The cut is then closed with stitches or staples.

Radical nephrectomy or open kidney removal:

• Your surgeon will make a cut about 8 to 12 inches (20 to 30 cm) long. This cut will be on the front of your belly, just below your ribs. It may also be done through your side.
• Muscle, fat, and tissue are cut and moved. The tube that carries urine from the kidney to the bladder (ureter) and blood vessels are cut away from the kidney. The kidney is then removed.
• Your surgeon will also take out the surrounding fat, and sometimes the adrenal gland and some lymph nodes.
• The cut is then closed with stitches or staples.

Laparoscopic kidney removal:

• Your surgeon will make 3 or 4 small cuts, most often no more than 1 inch (2.5 cm) each, in your belly and side. The surgeon will use tiny probes and a camera to do the surgery.
• Towards the end of the procedure, your surgeon will make one of the cuts larger (about 4 inches or 10 cm) to take out the kidney.
• The surgeon will cut the ureter, place a bag around the kidney, and pull it through the larger cut.
• This surgery may take longer than an open kidney removal. However, most people recover faster and feel less pain after this type of surgery when compared to the pain and recovery period following open surgery.

Sometimes, your surgeon may make a cut in a different place than described above.

Some hospitals and medical centers are doing this surgery using robotic tools.

Why the Procedure Is Performed

Kidney removal may be recommended for:

• Someone donating a kidney
• Birth defects
• Kidney cancer or suspected kidney cancer
• A kidney damaged by infection, kidney stones, or other problems
• To help control high blood pressure in someone who has problems with the blood supply to their kidney
• Very bad injury (trauma) to the kidney that cannot be repaired

Risks

Risks of any surgery are:

• Blood clots in the legs that may travel to the lungs
• Breathing problems
• Infection, including in the surgical wound, lungs (pneumonia), bladder, or kidney
• Blood loss
• Heart attack or stroke during surgery
• Reactions to medicines

Risks of this procedure are:

• Injury to other organs or structures
• Kidney failure in the remaining kidney
• After one kidney is removed, your other kidney may not work as well for awhile
• Hernia of your surgical wound

Before the Procedure

Tell your surgeon or nurse if:

• You are or could be pregnant
• You are taking any medicines, including medicines, drugs, supplements, or herbs you bought without a prescription
• You have been drinking a lot of alcohol, more than 1 or 2 drinks a day

Planning for your surgery:

• If you have diabetes, heart disease, or other medical conditions, your surgeon may ask you to see the provider who treats you for these conditions.
• If you smoke, it's important to cut back or quit. Smoking can slow healing and increase the risk for blood clots. Ask your provider for help quitting smoking.
• If needed, prepare your home to make it easier to recover after surgery.
• Ask your surgeon if you need to arrange to have someone drive you home after your surgery.

During the week before your surgery:

• You may be asked to temporarily stop taking medicines that keep your blood from clotting. These medicines are called blood thinners. This includes over-the-counter medicines and supplements such as aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), and vitamin E. Many prescription medicines are also blood thinners.
• Ask your surgeon which medicines you should still take on the day of surgery.
• Let your surgeon know about any illness you may have before your surgery. This includes COVID-19, a cold, flu, fever, herpes breakout, or other illness. If you do get sick, your surgery may need to be postponed.

On the day of the surgery:

• You will most often be asked not to drink or eat anything after midnight the night before the surgery.
• Take the medicines as you have been told, with a small sip of water.
• You will be told when to arrive at the hospital.

After the Procedure

You will stay in the hospital for 1 to 7 days, depending on the type of surgery you have. During a hospital stay, you may:

• Be asked to sit on the side of the bed and walk on the same day of your surgery
• Have a tube or catheter that comes from your bladder
• Have a drain that comes out through your surgical cut
• Not be able to eat the first 1 to 3 days, and then you will begin with liquids
• Be encouraged to do breathing exercises
• Wear special stockings, compression boots, or both to prevent blood clots
• Receive shots under your skin to prevent blood clots
• Receive pain medicine into your veins or pills

Recovering from open surgery may be painful because of where the surgical cut is located. Recovery after a laparoscopic procedure is most often quicker with less pain.

Outlook (Prognosis)

The outcome is most often good when a single kidney is removed. If both kidneys are removed, or the remaining kidney does not work well enough, you will need dialysis or a kidney transplant.

References

Moreira DM, Kavoussi LR. Laparoscopic and robotic surgery of the kidney. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 102.

Olumi AF, Blute ML. Open surgery of the kidney. In: Partin AW, Dmochowski RR, Kavoussi LR, Peters CA, eds. Campbell-Walsh-Wein Urology. 12th ed. Philadelphia, PA: Elsevier; 2021:chap 101.

Weiss RH, Jaimes EA, Hu SL. Kidney cancer. In: Yu ASL, Chertow GM, Luyckx VA, Marsden PA, Skorecki K, Taal MW, eds. Brenner and Rector's The Kidney. 11th ed. Philadelphia, PA: Elsevier; 2020:chap 41.