Nephrectomy
Encyclopedia
Nephrectomy is the surgical removal of a kidney
.
on August 2, 1869 in Heidelberg
. Simon practiced the operation beforehand in animal experiments. He proved that one healthy kidney can be sufficient for urine excretion in humans.
, a non-functioning kidney (which may cause high blood pressure) and a congenitally small kidney (in which the kidney is swelling, causing it to press on nerves which can cause pain in unrelated areas such as the back). Nephrectomy for renal cell carcinoma is rapidly being modified to allow partial removal of the kidney. Nephrectomy is also performed for the purpose of living donor
kidney transplantation
. Partial Nephrectomy has also been performed to repair injury e.g. rupture, caused by trauma such as falls and motor vehicle accidents.
to reach the kidney. Depending on circumstances, the incision can also be made midline. The ureter
and blood vessels are disconnected, and the kidney is then removed. The surgery can be done as open surgery, with one incision, or as a laparoscopic procedure
, with three or four small cuts in the abdominal and flank area. Recently, this procedure is performed through a single incision in the patient's belly-button. This advanced technique is called as single port laparoscopy
.
In January 2009, a woman who had previously had a hysterectomy was able to donate a kidney and have it removed through her vagina. The operation took place at Johns Hopkins Medical Center
. This is the first time a healthy kidney has been removed via this method, though it has been done in the past for nephrectomies carried out due to pathology
. Removing organs through orifices prevents some of the pain of an incision and the need for a cosmetically unappealing larger scar. Any advance which leads to a decrease in pain and scarring has the potential to boost donor numbers. This operation also has taken place at the Cleveland Clinic. The first transvaginal Nephrectomy actually took place at the Cleveland Clinic in Cleveland Ohio.
For some illnesses, there are alternatives today that do not require the extraction of a kidney. Such alternatives include renal embolization for those who are poor candidates for surgery, or partial nephrectomy if possible.
More rarely, renal cell cancers can involve adjacent organs, yet may be safely and completely removed surgically via open or laparoscopic techniques.
with fluids is administered. Electrolyte
balance and fluids are carefully monitored, because these are the functions of the kidneys. It is possible that the remaining kidney does not take over all functionality. A patient has to stay in the hospital between 2 and 7 days depending on the procedure and complications.
Kidney
The kidneys, organs with several functions, serve essential regulatory roles in most animals, including vertebrates and some invertebrates. They are essential in the urinary system and also serve homeostatic functions such as the regulation of electrolytes, maintenance of acid–base balance, and...
.
History
The first successful nephrectomy was performed by the German surgeon Gustav SimonGustav Simon (physician)
Gustav Simon was a German surgeon.In 1848 he earned his medical doctorate from the University of Giessen, and from 1848 to 1861 served as a military physician with a Hessian troop outfit. During this time he also worked at a small hospital in Darmstadt that he co-founded...
on August 2, 1869 in Heidelberg
Heidelberg
-Early history:Between 600,000 and 200,000 years ago, "Heidelberg Man" died at nearby Mauer. His jaw bone was discovered in 1907; with scientific dating, his remains were determined to be the earliest evidence of human life in Europe. In the 5th century BC, a Celtic fortress of refuge and place of...
. Simon practiced the operation beforehand in animal experiments. He proved that one healthy kidney can be sufficient for urine excretion in humans.
Indications
There are various indications for this procedure, such as renal cell carcinomaRenal cell carcinoma
Renal cell carcinoma is a kidney cancer that originates in the lining of the proximal convoluted tubule, the very small tubes in the kidney that filter the blood and remove waste products. RCC is the most common type of kidney cancer in adults, responsible for approximately 80% of cases...
, a non-functioning kidney (which may cause high blood pressure) and a congenitally small kidney (in which the kidney is swelling, causing it to press on nerves which can cause pain in unrelated areas such as the back). Nephrectomy for renal cell carcinoma is rapidly being modified to allow partial removal of the kidney. Nephrectomy is also performed for the purpose of living donor
Organ donation
Organ donation is the donation of biological tissue or an organ of the human body, from a living or dead person to a living recipient in need of a transplantation. Transplantable organs and tissues are removed in a surgical procedure following a determination, based on the donor's medical and...
kidney transplantation
Kidney transplantation
Kidney transplantation or renal transplantation is the organ transplant of a kidney into a patient with end-stage renal disease. Kidney transplantation is typically classified as deceased-donor or living-donor transplantation depending on the source of the donor organ...
. Partial Nephrectomy has also been performed to repair injury e.g. rupture, caused by trauma such as falls and motor vehicle accidents.
Procedure
The surgery is performed with the patient under general anesthesia. The surgeon makes an incision in the side of the abdomenAbdomen
In vertebrates such as mammals the abdomen constitutes the part of the body between the thorax and pelvis. The region enclosed by the abdomen is termed the abdominal cavity...
to reach the kidney. Depending on circumstances, the incision can also be made midline. The ureter
Ureter
In human anatomy, the ureters are muscular tubes that propel urine from the kidneys to the urinary bladder. In the adult, the ureters are usually long and ~3-4 mm in diameter....
and blood vessels are disconnected, and the kidney is then removed. The surgery can be done as open surgery, with one incision, or as a laparoscopic procedure
Laparoscopic surgery
Laparoscopic surgery, also called minimally invasive surgery , bandaid surgery, or keyhole surgery, is a modern surgical technique in which operations in the abdomen are performed through small incisions as opposed to the larger incisions needed in laparotomy.Keyhole surgery makes use of images...
, with three or four small cuts in the abdominal and flank area. Recently, this procedure is performed through a single incision in the patient's belly-button. This advanced technique is called as single port laparoscopy
Single port laparoscopy
Single port laparoscopy , also known as single port access surgery , single port incisionless conventional equipment-utilizing surgery , single incision laparoscopic surgery , Single access endoscopic surgery , laparo-endoscopic single-site surgery , natural orifice transumbilical surgery , and one...
.
In January 2009, a woman who had previously had a hysterectomy was able to donate a kidney and have it removed through her vagina. The operation took place at Johns Hopkins Medical Center
Johns Hopkins Hospital
The Johns Hopkins Hospital is the teaching hospital and biomedical research facility of Johns Hopkins University School of Medicine, located in Baltimore, Maryland . It was founded using money from a bequest by philanthropist Johns Hopkins...
. This is the first time a healthy kidney has been removed via this method, though it has been done in the past for nephrectomies carried out due to pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
. Removing organs through orifices prevents some of the pain of an incision and the need for a cosmetically unappealing larger scar. Any advance which leads to a decrease in pain and scarring has the potential to boost donor numbers. This operation also has taken place at the Cleveland Clinic. The first transvaginal Nephrectomy actually took place at the Cleveland Clinic in Cleveland Ohio.
For some illnesses, there are alternatives today that do not require the extraction of a kidney. Such alternatives include renal embolization for those who are poor candidates for surgery, or partial nephrectomy if possible.
More rarely, renal cell cancers can involve adjacent organs, yet may be safely and completely removed surgically via open or laparoscopic techniques.
After care
Pain medication is often given to the patient after the surgery because of pain at the site of the incision. An IVIntravenous therapy
Intravenous therapy or IV therapy is the infusion of liquid substances directly into a vein. The word intravenous simply means "within a vein". Therapies administered intravenously are often called specialty pharmaceuticals...
with fluids is administered. Electrolyte
Electrolyte
In chemistry, an electrolyte is any substance containing free ions that make the substance electrically conductive. The most typical electrolyte is an ionic solution, but molten electrolytes and solid electrolytes are also possible....
balance and fluids are carefully monitored, because these are the functions of the kidneys. It is possible that the remaining kidney does not take over all functionality. A patient has to stay in the hospital between 2 and 7 days depending on the procedure and complications.