Partial removal of the kidney

What is this?

This involves removal of part of the kidney ± the adrenal with surrounding fat and lymph nodes for suspected cancer of the kidney, using an incision either in the abdomen or in the side

What alternatives are there?

Observation, occasionally immunotherapy, total nephrectomy by open or laparoscopic (telescopic or minimally-invasive) approach, partial nephrectomy by laparoscopic (telescopic or minimally-invasive) approach

What to expect before procedure

You will usually be admitted the day before your surgery. You will normally receive an appointment for pre-assessment, approximately 14 days before your admission, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. After admission, you will be seen by members of the medical team which may include the Consultant, Specialist Registrar, House Officer and your named nurse. You will be asked not to eat or drink for 6 hours before surgery and, immediately before the operation, you may be given a pre-medication by the anaesthetist which will make you dry-mouthed and pleasantly sleepy. You will be given an injection under the skin of a drug (Clexane), that, along with the help of elasticated stockings provided by the ward, will help prevent thrombosis (clots) in the veins.

What happens during the procedure?

Normally, a full general anaesthetic will be used and you will be asleep throughout the procedure. In some patients, the anaesthetist may also use an epidural anaesthetic which improves or minimises pain post-operatively. You will usually be given injectable antibiotics before the procedure, after checking for any allergies. The kidney is usually removed through an incision in your loin although, on occasions, the incision is made in the front of the abdomen or extended into the chest area. A bladder catheter is normally inserted post-operatively, to monitor urine output, and a drainage tube is usually placed through the skin into the bed of the kidney. Often, a small tube (or stent) is placed within the collecting system of the kidney to help with healing. This will need to be removed by a second procedure, usually performed telescopically via the bladder under local anaesthetic. Occasionally, it may be necessary to insert a stomach tube through your nose, If the operation was particularly difficult, to prevent distension of your stomach and bowel with air.

After the procedure

You will be given fluids to drink from an early stage after the operation and you will start a light diet within 2-3 days. You will be encouraged to mobilise early to prevent blood clots in the veins of your legs. The wound drain will need to stay in place for 1 week in case urine leaks from the cut kidney surface. In some patients, the drain needs to stay in place longer and you will then go home with the drain and catheter still in place to allow the kidney to heal fully. The average hospital stay is 9 days.

Potential side effects