| Nephrectomy | |
|---|---|
 Before and after a radical nephrectomy | |
| ICD-9-CM | 55.5 |
| MeSH | D009392 |
| OPS-301 code | 5-554 |
A nephrectomy is the surgical removal of a kidney, performed to treat a number of kidney diseases including kidney cancer. It is also done to remove a normal healthy kidney from a living or deceased donor, which is part of a kidney transplant procedure. [1]
The first recorded nephrectomy was performed in 1861 by Erastus B. Wolcott in Wisconsin. [2] The patient had had a large tumor and the operation was initially successful, but the patient died fifteen days later. [3] [4] The first planned nephrectomy was performed by the German surgeon Gustav Simon on August 2, 1869, in Heidelberg. [5] [6] Simon practiced the operation beforehand in animal experiments. He proved that one healthy kidney can be sufficient for urine excretion in humans. [7]
There are various indications for this procedure, including renal cell carcinoma, a non-functioning kidney (which may cause high blood pressure) and a congenitally small kidney (in which the kidney is swelling, causing it to press on nerves, which can cause pain in unrelated areas such as the back). [8]
Nephrectomy for renal cell carcinoma is rapidly being modified to allow partial removal of the kidney. Nephrectomy is also performed for the purpose of living donor kidney transplantation. [1] A nephroureterectomy is the removal of a kidney and the entire ureter and a small cuff of the bladder for urothelial cancer of the kidney or ureter. [9]
The surgery is performed with the patient under general anesthesia. A kidney can be removed through an open incision or by laparoscopic surgery. For the open procedure, the surgeon makes an incision in the side of the abdomen to reach the kidney. Depending on circumstances, the incision can also be made midline. The ureter and blood vessels are disconnected, and the kidney is then removed. The laparoscopic approach utilizes three or four small (5–10 mm) cuts in the abdominal and flank area. The kidney is completely detached inside the body and then placed in a bag. One of the incisions is then expanded to remove the kidney for cancer operations. If the kidney is being removed for other causes, it can be morcellated and removed through the small incisions. Recently, this procedure is performed through a single incision in the patient's navel. This advanced technique is called single port laparoscopy.[ citation needed ]
A total nephrectomy is the removal of at least the entire kidney, whereas a 'radical nephrectomy' also includes at least some perinephric fat, possibly including Gerota's fascia, and usually also the ipsilateral adrenal gland. [10]
For some illnesses, there are alternatives today that do not require the extraction of a kidney. Such alternatives include renal embolization [11] for those who are poor candidates for surgery, or partial nephrectomy if possible.[ citation needed ]
Occasionally renal cell cancers can involve adjacent organs, including the inferior vena cava (IVC), the colon, the pancreas or the liver. If the cancer has not spread to distant sites, it may be safely and completely removed surgically via open or laparoscopic techniques. [12]
In January 2009, a woman who had previously had a hysterectomy was able to donate a kidney and have it removed through her vagina. The operation took place at Johns Hopkins Medical Center. This is the first time a healthy kidney has been removed via this method, though it has been done in the past for nephrectomies carried out due to pathology. Removing organs through orifices prevents some of the pain of an incision and the need for a cosmetically unappealing larger scar. Any advance which leads to a decrease in pain and scarring has the potential to boost donor numbers. [13] This operation has also taken place at the Cleveland Clinic, which first performed transvaginal Nephrectomy. [14] Living donation has a mortality risk of 0.03% during the procedure and seems to result in similar health outcomes to controls. [15] [16]
Pain medication is often given to the patient after the surgery because of pain at the site of the incision. An IV with fluids is administered. Electrolyte balance and fluids are carefully monitored, because these are the functions of the kidneys. It is possible that the remaining kidney does not take over all functionality. A patient has to stay in the hospital between 2 and 7 days depending on the procedure and complications. Patients who have had open surgery will have to stay in hospital longer than those who have had laparoscopic surgery. [17] In long-term, a person with only one kidney ("solitary kidney") may be more prone to developing chronic kidney disease (CKD). [18] A 2014 study suggested that lifelong risk of CKD is several-fold higher in kidney donors, although the absolute risk is still very small. [19] A 2017 article in the New England Journal of Medicine suggests that persons with only one kidney including those who have donated a kidney for transplantation or those whose kidney was removed for cancer, should avoid high protein diet and limit their protein intake to less than one gram per kilogram body weight per day in order to reduce the long-term risk of CKD. [20]
| Partial Nephrectomy | |
|---|---|
 Before and after a partial nephrectomy | |
| ICD-9-CM | 55.4 |
| MeSH | D009392 |
| OPS-301 code | 5-554 |
Partial nephrectomy is the surgical removal of a kidney tumor along with a thin rim of normal kidney, with the two aims of curing the cancer and preserving as much normal kidney as possible.[ citation needed ]
Czerny first described a partial nephrectomy in 1890. [21] However, due to limited x-ray and imaging capabilities to find small kidney tumors and significant complications associated with early operations it was largely abandoned. More recently, with improved imaging, improved surgical techniques and increased kidney tumor detection, partial nephrectomy is performed more often. [22]
A partial nephrectomy should be attempted when there is a kidney tumor in a solitary kidney, when there are kidney tumors in both kidneys, or when removing the entire kidney could result in kidney failure and the need for dialysis.
Partial nephrectomy is also the standard of care for nearly all patients with small renal masses (<4 cm in size). [22] Most renal masses between 4-7 centimeters can also be treated by partial nephrectomy if they are located in the proper position. [23] Renal masses larger than 7 centimeters are generally treated with radical nephrectomy unless the tumor occurs in a solitary kidney, there are tumors on both sides or kidney function is bad. Patients who are told their tumors are too big or too hard for a partial nephrectomy may want to seek another opinion because surgeons who take care of many patients with kidney cancer are more often able to spare the kidney than those who only see a few cases. [24]
A partial nephrectomy is performed with a patient under general anesthesia as well. A partial nephrectomy can be performed through an open, laparoscopic [25] or robotic approach. The patient is typically placed on the operating room bed lying on the side opposite the kidney tumor. The goal of the procedure is to remove the kidney tumor along with a thin rim of normal kidney tissue. Because the kidneys clean the blood, all blood eventually flows through the kidneys and 25% of it will go into the kidneys with each heart beat. In order to safely remove the kidney tumor, the blood flow to the kidney is often temporarily blocked off. The tumor is then cut out and the surgeon must sew the remaining kidney back together. Partial nephrectomy is often an alternative to complete, or radical, nephrectomy for renal cell cancer.[ citation needed ]
Patients who undergo partial nephrectomy experience complications around 15-25% of the time. [25] [26] The most common complications are bleeding, infection, and urinary leak. [25]
Partial nephrectomy offers the same chance of cure from the renal cell cancer as radical nephrectomy. [22] [23] This was confirmed in a recent meta-analysis. [27] Partial nephrectomy has been shown to maintain kidney function better than total removal. [23] There is some debate whether this preservation of kidney function leads to long-term benefits to the patient. [28] Some studies have found that patients treated by partial nephrectomy live longer than patients who had their whole kidney removed. [23] Other studies have found the opposite. [29] Partial nephrectomy has been associated with better quality of life compared to radical nephrectomy. [30]
Laparoscopy is an operation performed in the abdomen or pelvis using small incisions with the aid of a camera. The laparoscope aids diagnosis or therapeutic interventions with a few small cuts in the abdomen.
Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.
Renal cell carcinoma (RCC) is a kidney cancer that originates in the lining of the proximal convoluted tubule, a part of the very small tubes in the kidney that transport primary urine. RCC is the most common type of kidney cancer in adults, responsible for approximately 90–95% of cases. It is more common in men. It is most commonly diagnosed in the elderly.
Cystectomy is a medical term for surgical removal of all or part of the urinary bladder. It may also be rarely used to refer to the removal of a cyst. The most common condition warranting removal of the urinary bladder is bladder cancer.
Prostatectomy is the surgical removal of all or part of the prostate gland. This operation is done for benign conditions that cause urinary retention, as well as for prostate cancer and for other cancers of the pelvis.
Vaginectomy is a surgery to remove all or part of the vagina. It is one form of treatment for individuals with vaginal cancer or rectal cancer that is used to remove tissue with cancerous cells. It can also be used in gender-affirming surgery. Some people born with a vagina who identify as trans men or as nonbinary may choose vaginectomy in conjunction with other surgeries to make the clitoris more penis-like (metoidioplasty), construct of a full-size penis (phalloplasty), or create a relatively smooth, featureless genital area.
Adrenalectomy is the surgical removal of one or both adrenal glands. It is usually done to remove tumors of the adrenal glands that are producing excess hormones or is large in size. Adrenalectomy can also be done to remove a cancerous tumor of the adrenal glands, or cancer that has spread from another location, such as the kidney or lung. Adrenalectomy is not performed on those who have severe coagulopathy or whose heart and lungs are too weak to undergo surgery. The procedure can be performed using an open incision (laparotomy) or minimally invasive laparoscopic or robot-assisted techniques. Minimally invasive techniques are increasingly the gold standard of care due to shorter length of stay in the hospital, lower blood loss, and similar complication rates.
Vesicoureteral reflux (VUR), also known as vesicoureteric reflux, is a condition in which urine flows retrograde, or backward, from the bladder into one or both ureters and then to the renal calyx or kidneys. Urine normally travels in one direction from the kidneys to the bladder via the ureters, with a one-way valve at the vesicoureteral (ureteral-bladder) junction preventing backflow. The valve is formed by oblique tunneling of the distal ureter through the wall of the bladder, creating a short length of ureter (1–2 cm) that can be compressed as the bladder fills. Reflux occurs if the ureter enters the bladder without sufficient tunneling, i.e., too "end-on".
Single-port laparoscopy (SPL) is a recently developed technique in laparoscopic surgery. It is a minimally invasive surgical procedure in which the surgeon operates almost exclusively through a single entry point, typically the patient's navel. Unlike a traditional multi-port laparoscopic approach, SPL leaves only a single small scar.
Mani Menon, born 9 July 1948 in Trichur, India, is an American surgeon whose work has helped to lay the foundation for modern Robotic Cancer Surgery. He is the founding director and the Raj and Padma Vattikuti Distinguished Chair of the Vattikuti Urology Institute at the Henry Ford Hospital in Detroit, MI, where he established the first cancer-oriented robotics program in the world. Menon is widely regarded for his role in the development of robotic surgery techniques for the treatment of patients with prostate, kidney, and bladder cancers, as well as for the development of robotic kidney transplantation.
Douglas S. Scherr is an American surgeon and specialist in Urologic Oncology. He is currently the Clinical Director of Urologic Oncology at Weill Cornell Medicine. He also holds an appointment at the Rockefeller University as a Visiting Associate Physician. Scherr was the first physician at Cornell to perform a robotic prostatectomy as well as a robotic cystectomy.
Kidney tumours are tumours, or growths, on or in the kidney. These growths can be benign or malignant.
Fraley syndrome is a condition where the superior infundibulum of the upper calyx of the kidney is obstructed by the crossing renal artery branch, causing distension and dilatation of the calyx and presenting clinically as haematuria and nephralgia. Furthermore, when the renal artery obstructs the proximal collecting system, filling defects can occur anywhere in the calyces, pelvis, or ureter.
Ureteral cancer is cancer of the ureters, muscular tubes that propel urine from the kidneys to the urinary bladder. It is also known as ureter cancer, renal pelvic cancer, and rarely ureteric cancer or uretal cancer. Cancer in this location is rare. Ureteral cancer becomes more likely in older adults, usually ages 70–80, who have previously been diagnosed with bladder cancer.
Orchiectomy is a surgical procedure in which one or both testicles are removed. The surgery can be performed for various reasons:
Dr. Michael A. Palese, is an American urologist specializing in robotic, laparoscopic and endoscopic surgery, with a special emphasis on robotic surgeries relating to kidney cancer and kidney stone disease.
Craig G. Rogers, is an American urologist and the Chair of Urology Vattikuti Urology Institute at the Henry Ford Hospital in Detroit, Michigan. Rogers is known for pioneering robotic kidney surgeries using da Vinci Surgical System including single incision robotic surgeries. He was part of a team which pioneered the use of an ultrasound probe in robotic kidney surgery. On February 9, 2009, he performed the first twittered live robotic surgery.
Michael D. Stifelman Michael D. Stifelman, M.D., is Chair of Urology at Hackensack University Medical Center, Director of Robotic Surgery at Hackensack Meridian Health, and Professor and Inaugural Chair of Urology at Hackensack Meridian School of Medicine.
John Ewart Alfred Wickham was a British urologist and surgeon, who was a pioneer of keyhole surgery and the autonomous transurethral resection of the prostate (TURP) robot, foreseeing the subsequent revolution in robotic surgery.
Gaetano Ciancio is an Italian American surgeon at the University of Miami who specializes in kidney transplant. He is the chief medical and academic officer of the Miami Transplant Institute and the director of its Kidney & Kidney-Pancreas Programs. His most significant contributions to medicine are related to surgically treating kidney cancer once it has spread to the inferior vena cava and in optimizing the immunosuppression protocol after kidney transplant.
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