Nephrectomy

Monday, January 11, 2010

Nephrectomy is the removal of one or both kidneys by means of a surgical procedure. The first successful nephrectomy was carried out by the German surgeon Gustav Simon on August 2, 1869, in Heidelberg, Germany, proving that one healthy kidney can be sufficient for urine excretion in humans. Simon had practiced the operation in animal experiments.

Nephrectomy has a simple and a radical approach. A simple nephrectomy is performed on patients with irreversible kidney damage because of severe traumatic injury, symptomatic chronic infection, and obstruction. Simple nephrectomy is also carried out to treat renovascular hypertension due to noncorrectable renal artery disease or severe unilateral parenchymal damage caused by nephrosclerosis, pyelonephritis, reflux dysplasia, or congenital dysplasia of the kidney. Radical nephrectomy is used for localized renal cell carcinoma. Radical nephrectomy is also indicated to treat locally advanced RCC and metastatic RCC.

To perform the surgery the patient must be under general anesthesia. Then, the surgeon makes an incision in the side of the abdomen 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 Access Surgery.