Partial Nephrectomy

Overview

What is a partial nephrectomy?

A partial nephrectomy is a type of surgery in which a surgeon removes part of your kidney to treat a disease or injury. Once your surgeon corrects the condition, they’ll reconstruct your kidney.

A surgeon’s goal during a partial nephrectomy is to remove the diseased or damaged part of your kidney while leaving as much healthy kidney tissue as possible. Maintaining kidney function is important because your kidneys are the main filters of your body, and they’re essential for life. Having two functioning kidneys helps your overall kidney function.

During a typical open partial nephrectomy, your healthcare provider will make one or more large cuts (incisions) in your abdomen. Your provider usually recommends this type of procedure if you have a large or invasive tumor on your kidney.

They may also perform the procedure laparoscopically. Laparoscopic surgery is less invasive than traditional open surgery. Your surgeon will make two to four small incisions in your abdomen of half an inch or less. They then insert a thin rod with a camera at the end (laparoscope) into one incision to see the inside of your body. They insert surgical tools into the other incisions.

You may be a candidate for a robotic partial nephrectomy if you have a small kidney tumor or if removing your entire kidney could result in kidney failure and the need for dialysis. A robotic partial nephrectomy is robotic-assisted surgery. Technology allows your provider to “pilot” the robot’s arms, letting them move much more precisely in hard-to-reach areas inside of your body. As a result, it’s much less invasive than an open partial nephrectomy.

How serious is a partial nephrectomy?

A partial nephrectomy is a major surgery. A surgeon will surgically access your kidney to fix a condition and restructure your kidney. Some surgery techniques are less invasive than others. Your surgeon is the best person to tell you which technique they recommend and why.

Who needs to have a partial nephrectomy?

A number of conditions may require a partial nephrectomy as treatment, including:

Procedure Details

What happens before a partial nephrectomy?

Before a partial nephrectomy, you’ll meet with a healthcare provider. The provider will also discuss what type of partial nephrectomy procedure is best for you. You may have an open partial nephrectomy or a robotic partial nephrectomy.

They’ll check your general health. They’ll also take your vitals (temperature, pulse and blood pressure).

Tell your healthcare provider about any prescription or over-the-counter (OTC) medications you’re taking. These include herbal supplements. Aspirin, anti-inflammatory drugs, certain herbal supplements and blood thinners can increase your risk of bleeding. Be sure to check with your healthcare provider before stopping any medications.

Tell the healthcare provider about any allergies you have as well. Include all known allergies. These include medications, skin cleaners like iodine or isopropyl alcohol, latex and foods.

Your healthcare provider will also give you specific directions on eating and drinking before your partial nephrectomy. You shouldn’t eat or drink anything after midnight the night before your surgery. If you must take medications, you should take them with a small sip of water.

If you have a kidney tumor and it’s smaller than 1.5 inches (4 centimeters) in size, your provider will likely recommend a robotic partial nephrectomy. But if your tumor is between 1.5 inches and 2.8 inches (4 cm and 7 cm), your provider may still be able to treat it, depending on its location in your kidney.

What happens during a partial nephrectomy?

A special team of healthcare providers will perform a partial nephrectomy. The team typically includes:

The anesthesiologist will sedate you (put you under) with general anesthesia. You won’t be awake, won’t move and won’t feel any pain during the procedure. After you’re under, a provider will insert a urinary catheter. A urinary catheter is a small, flexible tube that drains urine (pee) from your bladder into a bag.

The procedure varies according to whether you have an open partial nephrectomy or a robotic partial nephrectomy.

Open partial nephrectomy

During an open partial nephrectomy, the urologist will use a sharp, sterile knife (scalpel) to carefully make an incision in your flank. Your flank is the fleshy part on the side of your torso, between your hip and your ribs. The incision may be as long as 12 inches (30 centimeters). A large incision gives the urologist a clear look at your kidney. It also allows them to use their hands to correct the condition and reconstruct your kidney. The urologist will use a clamp to temporarily block blood vessels that transport blood into and out of your kidney. Then, they’ll use ice to cover your kidney. Ice lowers the temperature of your kidney, which slows the breakdown of tissue from lack of blood flow.

Robotic partial nephrectomy

During a robotic partial nephrectomy, the urologist will use a scalpel to make small incisions in your abdomen. The incisions are no bigger than about 3/4 of an inch (2 centimeters). They’ll insert a laparoscope (a thin rod with a camera) and the robotic surgical equipment into these small incisions. Next, they’ll fill your abdominal cavity with carbon dioxide gas. The gas expands the area, giving the urologist enough space to move the surgical equipment and access your kidney. They’ll use the robot to stop blood flow to your kidney, correct your condition and reconstruct your kidney.

Once your urologist finishes reconstructing your kidney, they’ll use stitches and/or staples to close your incisions. They may stitch small silicone tubes (drainage tubes) in your incision sites. These drainage tubes remove blood or fluid from inside your body. They’re typically only in place for a few days.

How long does a partial nephrectomy take?

A partial nephrectomy usually takes three to four hours to perform.

What happens after a partial nephrectomy?

After a partial nephrectomy, a healthcare provider will cover your stitches with bandages. If you have a tumor, they’ll send it to a laboratory so researchers can examine it.

Your anesthesiologist will stop putting anesthesia into your body. Within a few minutes, you’ll be conscious (awake), but you’ll very likely still feel groggy.

You’ll then move to a recovery room, where providers will wait for you to wake up more fully and track your overall health. Once you wake up, healthcare providers will treat your pain. A robotic partial nephrectomy is less painful than an open partial nephrectomy. However, you’ll still need pain medication and management techniques.

Anesthesia very commonly causes nausea. If you have nausea, a provider will give you medication to treat it.

You must maintain a liquid diet for one to two days after surgery. A liquid diet helps give your body time to recover. As you heal and recover, providers will reintroduce you to solid foods.

The day after surgery, providers will encourage you to get out of bed and walk. Walking encourages healing, promotes blood flow and restores function to your affected areas. It also helps prevent blood clots in your legs, pneumonia and other complications.

After two days, a provider will remove your urinary catheter.

Once your healthcare providers determine you’re healthy enough and no longer require monitoring, they’ll discharge you to go home. A family member or friend must drive you home. It’s also a good idea to have a family member or friend help take care of you for at least a few days after the procedure, as you won’t be able to lift anything for at least several days.

How long is a hospital stay for a partial nephrectomy?

The typical hospital stay after a robotic partial nephrectomy is one to two days.

The typical hospital stay after an open partial nephrectomy is three to four days.

Risks / Benefits

What are the advantages of a partial nephrectomy?

The primary advantage of a partial nephrectomy is that it corrects a condition that affects your kidneys. Some conditions, such as kidney cancer, are deadly without treatment. The risks of living with these conditions without treatment outweigh any risks associated with a partial nephrectomy in most people.

What are the risks or complications of a partial nephrectomy?

All surgical procedures have risks. Some risks of a partial nephrectomy include:

  • Anesthesia risks.
  • Healing problems.
  • Possible need for a blood transfusion.
  • Infection.
  • Mass of clotted blood (hematoma).
  • Blood clots.
  • Fluid buildup at surgical sites (seroma).

Recovery and Outlook

How long does it take to recover from a partial nephrectomy?

Your recovery depends on the type of partial nephrectomy, as well as your health history and any other conditions you have. Your healthcare provider is the best person to tell you the recovery timeline for your specific case.

Most people can resume normal activities eight to 12 weeks after an open partial nephrectomy. Recovery is faster after a robotic partial nephrectomy. Most people can resume normal activities four to six weeks after a robotic partial nephrectomy.

When can I go back to work?

You should be able to return to work about four weeks after a partial nephrectomy.

If you have a less physically demanding job, you may be able to return to work sooner.

If you have a more physically demanding job, it’s a good idea to schedule more time off.

When to Call the Doctor

When should I see my healthcare provider?

Schedule follow-up appointments with your healthcare provider. They’ll want to check your incisions and stitches. If you don’t have dissolvable stitches, they may remove your stitches after one to two weeks. If you have drainage tubes, they’ll remove those as well.

If your provider removed kidney cancer, they’ll also conduct tests to make sure your kidney cancer is gone. Most people get CT scans or other imaging tests at one month, 12 months and 24 months after their procedure to monitor their kidney health.

Contact your healthcare provider immediately if you experience any abnormal symptoms. Symptoms may include:

  • Blood in your urine (hematuria).
  • Heavy bleeding at your incision sites.
  • Discolored drainage from your incisions.
  • A fever of 100 degrees Fahrenheit (38 degrees Celsius) or higher.
  • Infection.
  • Bad odor around the surgical site.
  • Skin separation at your stitches.
  • Increased pain.

A note from Cleveland Clinic

A partial nephrectomy is a common and effective treatment for kidney cancer and other kidney conditions. There are two types of procedures: an open partial nephrectomy and a robotic partial nephrectomy. Your healthcare provider may recommend a robotic partial nephrectomy if you have a small tumor. However, some people may require an open procedure if they have a large tumor.

A partial nephrectomy is a common surgery, but it’s still a serious procedure. If you have any questions, reach out to your healthcare provider. They’re available to help and offer the best recommendations for your long-term health and quality of life.

Last reviewed by a Cleveland Clinic medical professional on 08/24/2022.

References

  • Cozar JM, Tallada M. Open Partial Nephrectomy in Renal Cancer: A Feasible Gold Standard Technique in All Hospitals. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2522334/) Adv Urol. 2008;2008:916463. Accessed 8/24/2022.
  • Meng MV. Robotic Surgery in Urology. In: McAninch JW, Lue TF, eds. Smith & Tanagho's General Urology, 19th Edition. McGraw Hill; 2020.
  • National Kidney Foundation. Nephrectomy. (https://www.kidney.org/atoz/content/nephrectomy) Accessed 8/24/2022.

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