Laparoscopic and Open Nephrectomy for kidney cancers and non-functioning kidneys / severe kidney injuries


Laparoscopic and Open Nephrectomy for kidney cancers and non-functioning kidneys / severe kidney injuries

Nephrectomy is the surgical removal of the whole kidney.

This is done for the following reasons:

  1. To treat kidney cancer
  2. To treat very severe kidney injuries
  3. To treat non-functioning or poorly functioning especially if it contains stones, tumor, or an infection that could be dangerous if left inside the body. Some obstructive kidneys produce hormones, which can increase blood pressure and then affect the opposite healthy kidney. There is a justification to remove severely damaged, scarred or nonfunctioning kidney due to traumatic injury or other diseases particularly those with kidney stones due to the higher incidence of malignant tumors in such patients compared with the normal population. Tumors in non-functioning kidneys may be harder to diagnose as it does not take contrast to delineate cancers when CT scan is done.
  4. Removal of a healthy kidney from a donor is done (either living or deceased) for kidney transplantation.

Nephrectomy may either be

  1. Simple nephrectomy when only the whole kidney is removed
  2. Radical nephrectomy when the entire kidney and some additional structures are removed including the surrounding covering fasciae of the kidney, the ureter, or other adjacent structures such as the adrenal gland or lymph nodes
  3. Partial nephrectomy when only part of the kidney is removed, as in small kidney tumors especially at the upper or lower poles of the kidney, or when there is a non-functioning part of a duplicated / duplex kidney, when one moiety of the kidney is removed.

Nephrectomy may either be done by an open technique where an incision of about 10-12 cm is done on the side of your body, or laparoscopically where it is done by a key-hole surgery with 3-4 small incisions measuring 1 cm at your abdomen, and an incision lower down at the abdomen about 5-8 cm (depending on the size of your kidney) to remove the kidney.

Before the removal of the whole or part of your kidney, the doctor may advise you for further investigations including ultrasound of your kidneys, blood tests, a fitness check, CT scan of the kidneys and at times CT angiogram of the kidneys to assess for the blood vessel orientation of your kidney.

The urologist will discuss with you the indication, risks, expectations of the operation, as well as the preparation needed before the operation and how you will manage after the operation.

Laparoscopic (key-hole) surgery

Laparoscopic surgery to remove kidney, using multiple small key-hole incisions

Large skin incision when open removal of the kidney was done

Keyhole incision scar after removal of the kidney when done laparoscopically

Partial nephrectomy of a localized kidney cancer

Partial nephrectomy of a localized kidney cancer

Open Operations – rarely done nowadays

Position for open kidney operations