Nephrectomy

Surgery to remove all or part of the kidneys is called a nephrectomy. It’s used to treat kidney cancer and kidney (renal) diseases and injuries. It’s also used to remove a healthy kidney from a donor as part of a kidney transplant. Most people are born with two kidneys, but it’s possible to live a healthy life with just one. Even without kidneys, you can still live well with the help of dialysis.

Nephrectomies are performed by urologic surgeons and nephrologists (medical kidney specialists). When used to treat kidney cancer, Penn Medicine surgeons specialize in removing kidney tumors while sparing healthy kidney tissue. Wherever possible, we use minimally invasive methods, such as robotic-assisted surgery, to remove both large and small tumors.

Nephrectomy surgery removes all or a portion of one kidney or both (bilateral nephrectomy). There are several different surgical techniques that can be used:

• Open nephrectomy: This is a traditional surgical approach with one single large incision in the abdomen or side of the abdomen. Surgeons may use an open nephrectomy to remove large or complex tumors.
• Laparoscopic nephrectomy: This is a minimally invasive technique where surgeons access the kidney through several small incisions. A thin instrument with a camera (laparoscope) is inserted to view the surgical area.
• Robotic nephrectomy: This is a minimally invasive technique where the surgeon uses robotic tools and special computers to perform kidney surgery. Only a urology surgeon who is trained and experienced in robotic surgery can perform this procedure.

Surgeons most often recommend a nephrectomy for kidney cancer, but there are other reasons this surgery is performed, including:

• Benign kidney tumors: These are noncancerous growths on the kidney.
• Kidney injury or disease: This includes conditions like kidney cysts or stones and acute kidney injuries that prevent the kidneys from filtering waste products from the blood.
• Kidney infection: Some untreated bacterial infections can cause permanent kidney damage and require surgery.
• Kidney donation: This surgery removes a healthy kidney from a donor for transplant.

A nephrectomy is typically performed in a hospital and can last several hours. Your surgeon will use laparoscopic, open, or robotic surgery, depending on your individual case. You’ll be given medicine (general anesthesia) to keep you asleep and pain-free during the procedure. The surgical team will insert a flexible tube (catheter) into your bladder to drain urine.

With an open nephrectomy, you may have up to a 12-inch incision. Because laparoscopic surgery is minimally invasive, the incision may be between three and four inches. Most patients stay in the hospital between one to five days after surgery.

While recovery varies depending on the type of nephrectomy, you should be able to return to most of your regular activities within four to six weeks.

• Pain management: After a nephrectomy, you might feel pain in your abdomen on the side of the kidney removal. Your surgeon will prescribe pain medication to help manage any discomfort.
• Wound care: It’s important to keep the incision area clean, dry, and protected, following your surgeon’s instructions. You may have some temporary bruising or redness, but this is normal.
• Activity limitations: Short walks, using the stairs, and light housework are okay. Avoid lifting anything heavier than 10 pounds until your surgeon clears you. Don’t do any heavy lifting or strenuous activities.
• Long-term care: If both kidneys are removed (bilateral nephrectomy), you’ll need another way to remove waste and toxins from your bloodstream. Your surgeon will discuss your options for dialysis or a kidney transplant.

Penn Medicine surgeons are trained on the advanced da Vinci® robotic surgical system. Our da Vinci robots provide the steady and precise movements needed for delicate procedures like kidney removal surgery.

In a robotic-assisted nephrectomy, the surgeon sits at a console near you, remotely guiding a robotic system that mimics their movements. High-definition cameras inserted through small abdominal incisions provide a clear, magnified, 3D view of the kidney. The robotic system offers greater range of motion than the human hand, using tiny surgical instruments for precise cutting and stitching. This makes it easier for surgeons to maximize long-term kidney function and can lead to better outcomes.

Robotic surgery allows more precise removal of tumors while preserving as much healthy kidney tissue as possible. Our surgeons can accurately reconstruct the remaining kidney to minimize complications like bleeding or urine leakage. And because robotic surgical tools are smaller and thinner than a human hand, this means you have smaller incisions.

Penn Medicine has one of the world’s most experienced robotic-assisted surgery teams. With this minimally invasive approach, you can expect:

• Less blood loss, scarring, and pain
• Lower risk of complications
• Shorter hospital stays
• Faster recoveries

Experts in kidney surgery

As a high-volume kidney surgery program, we treat many patients each year. Our surgeons excel at a variety of surgical techniques, including robotic-assisted nephrectomies and complex partial nephrectomies, often handling cases that other centers can’t. This includes surgeries for people with previous kidney operations or those whose weight makes surgery more challenging. This experience means fewer complications and better outcomes.

Our program also offers:

• Surgical expertise: Our highly skilled surgeons are national leaders in urologic cancer and minimally invasive surgery. Their advanced training enables them to successfully perform complex procedures.
• Treatment guidelines: Our internationally recognized kidney cancer experts develop treatment guidelines and teach advanced robotic techniques to physicians worldwide.
• Experience in complex surgeries: We excel in intricate, multi-organ surgeries. Our surgeons work alongside heart, vascular, and colorectal surgeons in the same operating room to remove complex tumors, like renal cell carcinoma and IVC thrombus.
• TumorGlow® technology: We use this technology’s special fluorescent dye to make kidney tumors glow during surgery. Our surgeons can perform more precise surgery as they can see and remove the tumors more easily.