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  is a surgical procedure in which the entire kidney with it's collecting system is
removed along with the adrenal gland and lymph glands of the same side.

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Ô Partial Nephrectomy or Hemi-Nephrectomy - In this procedure, a small part of one kidney is

removed.
Ô Simple Nephrectomy - In this procedure all of one kidney is removed.
Ô 


 - This procedure involves surgical removal of one kidney along with the
neighbouring adrenal gland and lymph nodes on the same side.
Ô Bilateral Nephrectomy - This procedure entails surgical removal of both the kidneys.
Ô Unilateral Nephrectomy - In this procedure only one kidney is removed.

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If you have renal cell carcinoma (stage I, II or III) of kidney or polycystic kidney disease that has
completely damaged your kidney tissue then you are an ideal candidate for 


 .

 
 



 
It is extremely crucial for your surgeon to assess your kidney function before 


 . A
thorough physical examination, ECG, chest x-ray, complete blood profile, complete kidney profile,
pulmonary function tests, blood gas analysis, blood typing and cross matching is done in case transfusion
is required during 


  surgery. Specialized tests like intravenous
pyelography,     , retrograde pyelography, cystourethrography, CT scan,
ultrasonography, MRI, renal angiography and renal venography will be performed for complete anatomic
assessment. You will be hospitalized at least one day before the surgery. Inform your surgeon about your
other health conditions and medications (including all the prescription, non-prescription medications,
nutritional supplements i.e. vitamins, minerals and herbal products). Refrain from taking aspirin or
Ibuprofen at least 2 weeks before 


 . Stop smoking a few weeks before



  to prevent healing problems during recovery period. Do not eat or drink any thing for at
least 10 - 12 hours before the 


 surgery.

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 is performed under general anesthesia. 


  can be performed
either by Open Abdominal approach or Laparoscopic approach. Abdominal approach can be anterior
subcostal (incision runs on the front of the abdomen across the rib cage), thoracoabdominal, or flank (on
the side) approach. The kidney is dissected free of it's attachments. The renal artery and vein are
dissected and cut, ureter is cut and the adrenal gland is freed and removed along with the kidney. A drain
will be left in and the wound will be closed. Laparoscopic


  is a minimally invasive
procedure in which the kidney is removed by making four small incisions (each about 3 inches wide).
Surgical instruments are used to free the kidney from it's surrounding structures and the kidney is
removed through an incision in the front of the abdominal wall below the navel. The renal artery, renal
vein and the ureter are then tied off and the incision is sutured. 


 when using
abdominal approach can take up to three hours. Laparoscopic 


  can take a little
longer.
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Following 


 , you will spend the next few hours in the recovery room to monitor your
heart and lung function and also to check for any immediate post operative complications like excessive
bleeding. You will be hospitalized for about 5 - 7 days and those days can be quite painful and
uncomfortable. You will be prescribed pain medication to cope with the pain. As with all other major
surgeries, you will be encouraged to do deep breathing and coughing exercises following



 . Avoid strenuous activities, heavy lifting and playing sports for 2 - 3 weeks after 



 . You will be able to return to your daily activities in 4 - 6 weeks. Your renal function would
be monitored closely to make sure that one kidney can take over and compensate for the loss of the
removed kidney.

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The outcome of 


  depends on the size and type of the cancer. The survival rate for
stage I Renal Cell Carcinoma (RCC) following 


  is 93%. This is for the tumour that
is confined to the kidney and has not spread to the outside tissues.

  ! 
 " 


 
enefits of 


 

Ô After 


 , the kidney on the opposite side compensates for the loss of one
kidney and undergoes hypertrophy urine production is about 75 - 80% close to normal. You can
lead a normal life with one kidney and have your kidney tumour removed by 



 . With Laparoscopic


 , there is shorter hospital stay, less pain
and quicker recovery.

isks of 


 

Ô Injury and perforation of internal organs like bowel, liver, spleen, pancreas and pleura
Ô Excessive bleeding and hemorrhage
Ô Failure of the opposite kidney
Ô Infection
Ô Other (rare) complications include heart attack, congestive heart failure, pulmonary embolism,
cerebrovascular accident, pneumonia, and thrombophlebitis.

!lternatives to 


 

Ô Cryosurgery - Renal Ablative Cryosurgery of localized renal cancer is a new technique that is
gradually gaining popularity.
Ô Nephron Sparing Surgery - This is the alternative of choice when it is necessary to preserve the
functioning renal parenchyma. This may be necessary in if you have renal cell carcinoma of both
the kidneys, or renal cell carcinoma of the single kidney that is functioning, chronic renal failure,
impairment of kidney function due to kidney stone, renal artery stenosis or diabetes.

ow or Never

Ô 


  is the appropriate treatment for kidney cancer that is localized. Chances
are that this would be the only treatment that you would require for your cancer. Your kidney
function will be compensated for by the opposite kidney and you will be able to live a normal life.

"ecision to have 



 

Ô 


  will not effect your bladder and you will not need a urostomy bag after the
surgery. 


  could be worthwhile having as the symptoms of kidney cancer
like pain, blood in the urine, fever or weakness can be relieved by removing the tumour.
Removing the kidney tumour by 


  can help you alleviate your symptoms