Preparing for nephrectomy

Nephrectomy simply means the removal of kidney. The term radical nephrectomy is used when the whole kidney together with its surrounding fatty tissue is removed.  In contrast, partial nephrectomy denotes the surgical removal of only a part of the kidney, leaving the bulk of normal kidney behind. Both are done mainly to remove tumours arising from the kidney. How much kidney is removed depends on the extent of the tumour and your overall kidney function. Most people can live with one healthy kidney without any major complications.

You will be put under general anaesthesia for the surgery. Radical or partial nephrectomy can be performed with a cut in the abdominal wall (open approach) or with the laparoscopic technique (also known as minimally-invasive surgery). Robotic-assisted surgery, which is a form of laparoscopic surgery, can be helpful for, and is an option in, more complex cases. 

The wounds of keyhole surgery are typically smaller compared to the open approach and patients generally recover faster, have less pain and discharge earlier compared to open surgery. However, in certain cases, laparoscopic surgery may not be suitable such as in patients with prior abdominal surgeries or very large tumours. 

Your urologist or a member of their team will review your history and medications before the surgery and discuss with you regarding your surgery to confirm your understanding and consent for surgery. The anaesthetist will perform their final assessments before putting you under anaesthesia for the procedure. The operation lasts an average of 2-3 hours depending on the complexity. Most patients stay in hospital for 2-3 days on average.

After the surgery, you will be under close monitoring to look for any complications of surgery. There will be a urinary catheter (urine tube draining urine from your bladder into a bag) and a drain will be placed around the area where your kidney was removed to prevent excessive fluid accumulation. These tubes are temporary and usually removed as soon as you are mobile or when not required anymore.

Most patients will feel pain over the operative site and the necessary painkillers will be administered to you depending on your level of pain. Some bloatedness (gaseous abdominal distension) is expected and usually temporary. In some cases, you may feel nausea after the surgery which may be a side effect of the anaesthetic drugs given to you during or after the surgery. Hence, most patients are not able to resume their usual diet immediately after surgery and are usually placed on intravenous (IV) drip and given fluids to drink first. Most patients are able to sit out of bed the next day and early movement is encouraged to help with recovery.