The information in the article is provided for informational purposes only and is not a guide to self-diagnosis and treatment. If symptoms of the disease appear, you should consult a doctor.
Nephrectomy is a surgical operation to remove a kidney, which is performed on patients in whom one of the kidneys has ceased to perform its function due to pathological changes or chronic disease.
The purpose of the kidneys in the human body is to purify the blood from toxic metabolic products accumulated in it and to remove toxins from the body with urine. The kidneys are a paired organ, so if one of them irreversibly loses its function, it can be removed, providing the patient with many years of life. The remaining kidney, having increased in size, will take on the entire burden of blood purification.
Indications for nephrectomy
The kidneys are very important for the human body, so there are not so many indications for their removal:
- long-term chronic diseases that have led to the formation of a shrunken kidney;
- polycystic kidney disease;
- abnormalities in the development of the organ;
- kidney damage, if they have caused purulent complications;
- detection of a malignant neoplasm in the kidney (kidney cancer);
- injury to the kidney that has caused its rupture;
- inoperable benign tumors that prevent the kidney from working.
A separate indication is removal a healthy kidney, if a person acts as a donor for a patient whose both kidneys have stopped functioning.
A non-functioning kidney has to be removed because, not performing its functions, it only brings inconvenience to the person:
- provokes lower back pain;
- causes problems with urination (incontinence, retention and change in urine volume);
- contributes to the development of edema of the face and upper body;
- can lead to the appearance of rashes and itching on the skin - manifestations of intoxication of the body with metabolic products;
- causes nausea, vomiting, dryness, thirst and a metallic taste in the mouth.
The presence of these symptoms does not necessarily indicate that the kidney needs to be removed. The feasibility of surgical removal can be determined only after a thorough examination of the patient. Surgeons always try to preserve the organ as much as possible, performing, if necessary, a partial nephrectomy, that is, removing only the part of the kidney affected by the pathological process.
But in cases where this is not possible, a radical nephrectomy is prescribed - the entire kidney is removed.
Preparation for kidney removal
The purpose of the preoperative examination is to find out whether the patient really cannot do without surgical intervention. Kidney function is analyzed, the presence of an acute inflammatory process is checked. All actions of the doctor are aimed at complete or partial preservation of the organ, but in some cases, such as cancer or very severe cases of renal failure, surgery is necessary.
The preoperative examination package includes:
- blood test - general, biochemical, for infections, coagulogram;
- general urine test - to assess the general condition of the urinary system and specifically the kidneys;
- ultrasound - to assess the extent of kidney damage and the degree of involvement of surrounding tissues in the process;
- in some cases, CT or MRI is prescribed for a similar purpose.
Consultations between the surgeon and anesthesiologist are mandatory so that the patient's immersion in anesthesia is safe. The complex of studies does not take much time and usually takes one or two days, but in the case of a serious condition of the patient, all studies are done faster.
The patient should not eat a day before the planned operation, and on the day of the operation, you should also refrain from drinking.
Performing laparoscopic nephrectomy
Nephrectomy is performed only under general anesthesia and can be open or laparoscopic. Open nephrectomy is performed through a wide incision, using different approaches. Laparoscopic removal of the kidney is performed through three to four punctures (small incisions) up to 10 millimeters in size.
Laparoscopic nephrectomy lasts longer than open surgery and can last from one to four hours. First, the patient is placed on his back, and holes are formed in the anterior abdominal wall, into which ports are inserted for the introduction of laparoscopic instruments. The inspection of the surgical field is formed by injecting carbon dioxide into the abdominal cavity, which raises the abdominal wall, forming a volume for manipulation.
After this, the patient is turned over onto his healthy side, and surgeons use laparoscopic instruments to cut off the affected kidney from the blood vessels that supplied it with blood supply. After that, the ureter is isolated and the distant organs are removed from the abdominal cavity. For this, an endobag is placed in the abdominal cavity, into which the diseased kidney is inserted. The neck of the bag is tightened and the bag together with the contents is removed through the fifth incision 5-8 centimeters long.
After successful removal, the surgeon drains the abdominal cavity, conducts a control examination of the surgical field, after which he removes the laparoscope and sews up the punctures.
Rehabilitation after nephrectomy
After the operation, the patient, before regaining consciousness, is transferred to the intensive care unit (resuscitation), where doctors constantly monitor his blood pressure and other vital signs, supporting them if necessary. Most patients require a few hours in the intensive care unit, but in some cases this time may increase.
After being transferred to a regular hospital ward, the patient remains under the supervision of doctors for a week or a little more, after which discharge is possible. During the hospitalization period, the patient is treated with medication, which consists of taking antibiotics, analgesics, and anti-inflammatory drugs.
Home treatment lasts about two to four weeks for patients who have undergone laparoscopic nephrectomy. Patients are hospitalized for up to six weeks after kidney removal.
In the postoperative period, the patient is on a diet. The first meal is allowed the next day, if the patient's condition does not cause concern. Small portions of broth, yogurt and cheese are allowed, further expansion of the diet to vegetable soups, cereals, juices, boiled meat and fish is possible only after the patient's first independent stool.
The diet continues after discharge, consisting in the rejection of salty, smoked, alcohol, spicy food. It is necessary to adhere to the diet until the end of the process of adaptation of the body to life with one kidney.
In addition to the diet, physical activity is limited, lifting weights is prohibited, at first it is necessary to wear a supporting bandage. The patient needs to protect himself, avoiding hypothermia.
Removal of the kidney at Oxford Medical
Address to the surgical hospital of the clinic «Oxford Medical Kyiv» allows patients to:
- receive advice from the best specialists with many years of experience and academic degrees;
- be operated on by qualified surgeons who have many years of experience in performing complex operations;
- the orientation of doctors to organ-preserving and minimally invasive interventions - the most favorable and safe for the patient;
- diagnostics (ultrasound, CT, digital X-ray), surgical intervention and postoperative rehabilitation within the walls of one clinic;
- a modern operating block for two operating rooms, equipped exclusively with new equipment (endoscopic racks, ultrasonic scalpel, argon laser, etc.);
- an intensive care unit with the function of 24-hour monitoring and support of the patient's vital signs;
- comfortable hospital wards designed for one or two patients.
Complications after kidney removal
As a result of any surgical intervention, the development of undesirable consequences for the patient's body is not excluded, and nephrectomy is no exception. The following complications may develop as a result of the operation:
- infection;
- blood loss requiring transfusion;
- postoperative pneumonia;
- hernias, adhesions;
- damage to tissues adjacent to the removed kidney;
- allergic reaction to anesthesia;
- renal failure, which develops in patients whose remaining kidney cannot cope with the increased load due to disease or other pathology.
It should be noted that the frequency of the listed complications in patients who underwent laparoscopic nephrectomy is lower than in patients operated on by open access.
In addition to fewer complications, laparoscopic access has several other advantages:
- minimal damage to adjacent tissues;
- minimal blood loss;
- less noticeable scars after surgery (unlike a wide incision with open access);
- no risk of adhesions and hernias;
- better overview of the surgical field by the surgeon thanks to the use of video cameras, light and magnification;
- reduction in rehabilitation time by several times.
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