What Is Nephrectomy

  • Pranjal Ajit YeoleBachelor's of Biological Sciences, Biology/Biological Sciences, General, University of Warwick, UK
  • Regina LopesSenior Nursing Assistant, Health and Social Care, The Open University

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Nephrectomy is a surgical procedure requiring the removal of a kidney. This plays a key role in the treatment of kidney conditions, such as kidney cancer or kidney disease.

Introduction to nephrectomy

Nephrectomy is a kidney removal surgery where a part or the entire kidney is surgically removed. There are two types of nephrectomy procedures based on the extent of removal of the kidney.

Partial nephrectomy is where the part of the diseased or injured kidney is surgically removed, leaving the healthy tissue in place. A radical nephrectomy is where the whole kidney, a section of the ureter adrenal gland and the fatty tissue surrounding the kidney is surgically removed.1

Indications for nephrectomy

Nephrectomy is usually done for the following purposes: kidney cancer or disease, and injury to the kidney due to trauma. It is also done to remove a healthy kidney from a live or deceased donor for a kidney transplant. 

One should avoid nephrectomy during:

  • Bleeding disorders
  • Decompensated diabetes
  • Mellitus decompensated heart failure 
  • Anticoagulation

Medication tests performed before the surgery include:

  • Urinalysis
  • Kidney function test 
  • Complete blood count (CBC)
  • ECG
  • CT scan
  • MRI scan

Preoperative preparation

Before surgery

In preparation for the surgery, you will meet with your urologist, who is a surgeon specialising in the kidneys and urinary tract. A medical staff will carry out an interview where your medical history will be reviewed. A physical examination is performed then testing may be ordered to assess the kidney cancer and your fitness for surgery. 

This testing may include:

  • Blood tests 
  • Urine tests 
  • Cardiogram - to check your heart
  • X-rays
  • CT scans or MRIs

Staging will be performed by the physical assessment blood tests and imaging studies to determine if the cancer is localised or is spread elsewhere in the body. Ask about your medications including what you should continue taking up to the time of surgery following this review you'll be asked to sign informed consent for surgery. This is a very important document indicating why the surgery must take place, other treatment options, what surgery consists of and what the potential risks there may be.2

Once the decision is made it is time to prepare for the surgery, in the days leading up to the operation focus on living healthy by eating a balanced diet and getting some regular exercise. Also, it has been found that if you stop smoking just before surgery there are distinct benefits regarding anaesthetic risk and recovery from surgery. Gathering the support of friends and family around you as well as other patients who have had the operation when possible can help ease your mind and comfort. 

A common instruction is to take nothing by mouth after midnight on the night before the operation. However individual instructions will vary and may include a bowel preparation: try to get a good night's sleep as it helps to go into surgery well rested.

Moreover, as individual situations will differ, follow the advice of your doctor or hospital regarding specific preoperative instructions. Finally, it is important to understand and come to terms with the expectations of surgery as well as the potential outcomes.2

Surgical procedure

On the day of surgery, the nurse will review your medical history and check your vital signs including your blood pressure, pulse and temperature. An intravenous or IV line will likely be started through which you will receive fluids and later medications.

During this process, you will meet with an anesthesiologist, who will administer anaesthetic drugs and monitor the vital functions. During surgery, the anesthesiologist will review different anaesthetic options for you and discuss their merits and potential risks.

A common part of the anaesthetic regimen used during a nephrectomy is an epidural line which allows the doctor to give drugs directly into the spinal cord and nerve roots to provide excellent and focused pain relief. Finally, before surgery you will meet once more with your surgeon and any final concerns can be addressed.

Depending on the severity of the diseased/cancerous kidney, nephrectomy varies.

The two types of surgeries are:

Partial nephrectomy

Where the surgeon removes the diseased or cancerous part of the kidney. This is also known as nephron-sparing or kidney-sparing surgery. During this, the surgeon removes the spares and the tumour of the kidney and replaces it with healthy tissue.3

Radical nephrectomy

Where the surgeon removes the entire kidney including the fatty tissues surrounding the kidney and a portion of the ureter (a tube connecting the kidney to the bladder). The adrenal gland that sits on top of the kidney may also be removed depending on the placement of the tumour. The chances of removal are high if the tumour sits close to the adrenal gland.4

Three different techniques are used for nephrectomy:

Laparoscopic surgery

This is the traditional open surgical approach chosen for very large tumours. For example, tumours that have developed locally into other adjacent organs or renal veins. These are IVC tumours that have expanded centrally into the inner part of the kidney.

On average, 3-5 small cuts are made in the stomach area where a device shaped like a wand tipped with a small video camera is inserted. This is called a laparoscopy and is inserted through the cuts to visualise the kidney.5

Robot-assisted laparoscopic surgery

This is where a robotic system is used to carry out the surgery. You must choose a surgeon who is extremely experienced in using this type of robotic system. Compared to other methods, this method enables more ease with the movement of tools along with the exactness compared to the standard laparoscopic surgery.5

Open surgery

This requires an incision between the ribs and hips. Using this incision the surgeon can use their hands to dissect and reconstruct the kidney. During the procedure, the blood vessels going into and out of the kidney are temporarily clamped and the kidney is cooled with ice to save as much kidney function as possible.

The clamps are eventually removed after the kidney is reconstructed after 20-30 minutes. The kidney will then turn pink typically with no bleeding from the reconstructed part of the kidney. The tumour is then sent to pathology for analysis.6

Post-operative care and recovery

The patient must maintain limited activity; avoiding heavy lifting or exercise for a month after surgery. Some patients with flank incisions may end up with a bulge in the area due to loss of muscle tone but this can be managed conservatively. Blood tests will also be required after six weeks of the procedure to maintain kidney function.6

Maintaining kidney function 

  • There will be regular checkups on how well the remaining kidney is functioning
  • Yearly urinalysis and blood pressure checks
  • Kidney function tests every few years 

Risks and complications

All surgeries come with risks and complications. Open partial nephrectomy has the lowest rate of serious complications such as postoperative bleeding or inadvertent loss of the kidney. After partial nephrectomy kidney, you may have normal kidney function. The doctor may recommend you eat a healthy diet so that your kidney performs its functions normally.7

The disadvantages of open partial nephrectomy:

  • Infections
  • Bleeding or haemorrhage
  • Postoperative pneumonia
  • Rare allergic reactions to anaesthesia
  • In rare circumstances, If the remaining kidney does not function properly it can lead to death 

Laparoscopic surgery techniques have different risks compared to open surgery. 

The advantages of laparoscopic surgery:

  • Recovery time is shortened
  • The need for painkillers is reduced 
  • Less scarring8

Despite there being several disadvantages the main advantage of nephrectomy is that it can be a life-saving procedure. 


In what circumstances, should I have my kidney removed?

The kidney should be fully removed or partly removed if the kidney is cancerous, damaged or diseased.

Is nephrectomy painful?

You may feel pain a few days after the surgery along with some discomfort however painkillers will be given to maintain this. This can be in the form of tablets or injections.

Am I going to be physically limited?

Yes, you should avoid any contact sports and strenuous exercise after surgery.


Nephrectomy is used to treat damaged and cancerous kidneys. Three techniques can be used to partially/fully remove the kidney. Despite there being disadvantages, it is a life-saving procedure and can allow the patient to prolong a better lifestyle.


  1. Novick AC. Laparoscopic and partial nephrectomy. Clinical Cancer Research [Internet]. 2004 Sep 15 [cited 2024 Apr 10];10(18):6322S-6327S. Available from: https://aacrjournals.org/clincancerres/article/10/18/6322S/281699/Laparoscopic-and-Partial-Nephrectomy
  2. Cleveland Clinic [Internet]. [cited 2024 Apr 10]. Nephrectomy: surgery types, what to expect, recovery. Available from: https://my.clevelandclinic.org/health/treatments/21515-nephrectomy
  3. Russo P. Open partial nephrectomy: an essential operation with an expanding role: Current Opinion in Urology [Internet]. 2007 Sep [cited 2024 Apr 10];17(5):309–15. Available from: http://journals.lww.com/00042307-200709000-00004
  4. Monk TG. Complications of radical urologic surgery. In: Complications in Anesthesia [Internet]. Elsevier; 2007 [cited 2024 Apr 10]. p. 846–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/B9781416022152502167
  5. Şahin S, Özdemir O, Ekşi M, Evren İ, Karadağ S, Özlü DN, et al. Comparison of incision types used for kidney extraction in laparoscopic donor nephrectomy: a retrospective study: incision types for kidney extraction. Urology Journal [Internet]. 2022 Nov 20 [cited 2024 Apr 10];(Instant 2022):7233. Available from: https://doi.org/10.22037/uj.v19i.7233
  6. Surgery to remove part or all of your kidney [Internet]. [cited 2024 Apr 10]. Available from: https://www.cancerresearchuk.org/about-cancer/kidney-cancer/treatment/surgery/removing-part-all
  7. Shuford MD, McDougall EM, Chang SS, LaFleur BJ, Smith JA, Cookson MS. Complications of contemporary radical nephrectomy: comparison of open vs. laparoscopic approach. Urologic Oncology: Seminars and Original Investigations [Internet]. 2004 Mar [cited 2024 Apr 10];22(2):121–6. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1078143903001376
  8. Minnee RC, Idu MM. Laparoscopic donor nephrectomy. Neth J Med. 2010 May;68(5):199–206.

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Master of Drug Discovery and Toxicology - MSc, University of Hertfordshire, England

Binita is a Clinical Contract Analyst with a distinguished background in the pharmaceutical industry, specializing in contracts for oncology clinical trials. Her expertise spans across various phases of clinical trials, from early-stage studies to late-phase studies, ensuring that new trials are set up efficiently across many countries. Binita's comprehensive knowledge of regulatory requirements and her adeptness in navigating complex clinical landscapes have been instrumental in the successful execution of many contracts. Her work is characterised by her commitment to precision and her collaborative approach. With a keen eye for detail and a deep understanding of the intricacies of oncology, Binita continues to drive progress in the pharmaceutical industry.

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