Open Partial Nephrectomy

What is an open partial nephrectomy?

An open partial nephrectomy is surgery to remove part of your kidney to treat a disease or injury. A surgeon removes diseased or damaged tissue while leaving as much healthy tissue as they can. This way, your kidney can still filter blood. 

During an open partial nephrectomy, your surgeon will make one or more large cuts in your belly. They usually use this approach when the tumor on your kidney is relatively small and the entire kidney doesn’t need to be removed.

What does this procedure treat?

Reasons for partial kidney removal include conditions like:

• Kidney cancer
• Infection
• Damage from kidney stones
• Injury
• Birth defects
• High blood pressure from problems with blood supply to your kidneys

How should I prepare for an open partial nephrectomy?

Before a partial nephrectomy procedure, you’ll meet with a healthcare provider. They’ll discuss what type of procedure is best for you. They’ll take your temperature, pulse and blood pressure.

Your provider will ask about any prescription or over-the-counter medicines you take. These include herbal supplements. Aspirin, anti-inflammatory drugs, certain herbal supplements and blood thinners can increase your risk of bleeding. You may need to stop taking them before surgery. Be sure to check with your provider before you stop taking them.

Mention any allergies you have. Include medications, skin cleaners like iodine or isopropyl alcohol, latex and foods.

Your provider will give you directions for fasting before your surgery. You typically can’t eat or drink anything after midnight the night before your operation. If you must take medications, you should take them with a small sip of water.

What happens during this procedure?

This procedure usually takes three to four hours to perform. During an open partial nephrectomy, your surgical team will:

1. Sedate you (put you under) with general anesthesia so you’ll be in a painless sleep
2. Insert a urinary catheter, a flexible tube that drains pee from your bladder into a bag
3. Make a 12-inch (30-cm) cut in your flank (side of your torso, between your hip and your ribs)
4. Use clamps to block blood vessels that move blood into and out of your kidney
5. Remove the part of the kidney that’s causing problems (for example, the tumor)
6. Sew or suture your kidney back together
7. Remove the clamps from your blood vessels
8. Possibly leave a temporary surgical drain (tube that comes out of your skin to drain any fluid from around the kidney)
9. Use stitches or staples to close the cut

What are the potential benefits and risks of this procedure?

The main advantage of a partial kidney removal is that it corrects kidney conditions. And it does this without removing your entire kidney. Some conditions, like kidney cancer, are fatal without treatment. The risks of living with these conditions without treatment outweigh any risks of a partial nephrectomy in most people.

A partial nephrectomy is a major surgery, and all surgeries have risks. Some risks of a partial nephrectomy include:

• Anesthesia reactions
• Healing problems
• Possible need for a blood transfusion
• Infection
• Bleeding or a mass of clotted blood (hematoma)
• Blood clots
• Fluid buildup at surgical sites (seroma)
• Kidney dysfunction

What happens after an open partial nephrectomy?

After a partial kidney removal, your healthcare team will:

1. Send the tumor to a lab so researchers can examine it
2. Stop putting anesthesia into your body so you wake up
3. Move you to a recovery room, where you’ll wake up more fully
4. Treat pain and nausea
5. Keep you on a liquid diet for one to two days after surgery to give your body time to recover
6. Encourage you to walk the day after surgery to improve blood flow and prevent complications
7. Remove the urinary catheter after one to two days
8. Send you home when it’s safe for you to leave

What is the recovery time for an open partial nephrectomy?

The typical hospital stay for an open partial nephrectomy is two to four days.

You won’t be able to lift anything for at least several days, so it’s a good idea to have a family member or friend help take care of you then.

Your recovery time after a partial kidney removal depends on the type of surgery, as well as your health history and any other conditions you have. Your surgeon will advise you not to lift anything heavier than 10 pounds or engage in strenuous activity (like running or biking) for four weeks after surgery. You can walk and take stairs; there are no restrictions on these. You can start driving when you’re off narcotic pain medications for 24 hours.

You should be able to return to work about four weeks after surgery. You may be able to go back to work sooner if your job doesn’t require you to exert yourself. If you have a more physically demanding job, it’s a good idea to take more time off.

When should I call my healthcare provider?

Schedule follow-up visits with your healthcare provider. If you have staples, a provider will need to remove these one to two weeks after surgery. If you have drainage tubes, they’ll remove those as well. You’ll need an appointment one to two weeks after surgery to discuss your pathology from surgery. (If a surgeon removes a tumor, pathologists will look at it under a microscope to find out what type of tumor it was.)

If your provider removed kidney cancer, they’ll also conduct tests to make sure the cancer is gone. Most people get CT scans or other imaging tests after surgery. Sometimes these are three months, six months or 12 months after surgery. It depends on what type of cancer was found.

Your provider will review the pathology with you at your follow-up visit and let you know what type of schedule you’ll need to be on for future imaging and blood work.

Contact your provider right away if you have any abnormal symptoms, like:

• Blood in your urine (hematuria)
• Heavy bleeding at your incision sites
• Discolored drainage from your cuts (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