Partial Nephrectomy: Surgery to Remove Part of Kidney
Medically reviewed by Kashif J. Piracha, MD
In a partial nephrectomy, a portion of your kidney is surgically removed, sparing some function in that kidney. This surgery is most often performed in instances of a small tumor localized to the kidney.
The procedure may be done by open surgery or a minimally-invasive laparoscopic "keyhole" surgery (that may be robot-assisted). With minimally invasive laparoscopic partial kidney removal, the surgery itself may be less taxing than traditional kidney removal, and the recovery may be quicker.
This article will explain why partial nephrectomy is selected, the purpose of the surgery, what happens during the procedure, recovery milestones, and more.
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Partial Nephrectomy Surgery Purpose
Also known as nephron-sparing surgery, the idea is to remove the part of the kidney with the tumor, injury, or other disease process and leave the remaining healthy tissue. The nephron is the filtering unit of the kidney. With enough nephrons and associated structures spared, the affected kidney can still function and remove waste from the body.
It's possible to remove a tumor of less than 7 centimeters (3 inches) in size and some surrounding tissue and leave the rest of the healthy kidney in place. The tumor must not have spread to the lymph nodes or organs beyond the kidney.
A partial nephrectomy may also sometimes be used for larger tumors if removing the whole kidney is not an option. For example, if a person has only one kidney and has a kidney tumor, a partial nephrectomy allows the person to maintain some kidney function and possibly avoid needing dialysis or a kidney transplant to survive.
The location of the tumor or other diseased tissue also determines whether a partial nephrectomy is possible. It is possible to do a partial nephrectomy if the tumor is toward the outside of the kidney but not if it is towards the middle of the kidney, where the blood supply enters.
What Happens During Partial Nephrectomy Surgery
A partial nephrectomy is performed in a surgical suite with general anesthesia. You will be admitted to the hospital for this procedure and recovery.
In a laparoscopic partial nephrectomy, the urology surgeon places thin instruments, including a camera, through three to four 1-centimeter (1/2-inch) incisions. Blood flow to the area is temporarily suspended to keep blood loss down. The tumor is meticulously cut away from the kidney and removed. The remaining tissue is repaired with sutures.
This laparoscopic procedure may be performed robotically. The surgeon uses a computer and robotic tools to perform the procedure rather than manipulating the instruments by hand. The robotic tools offer more precision and require smaller incisions.
If an open procedure is needed, one longer incision is manually made down your side, and a rib may need to be removed. This allows the surgeon to access your kidney and perform the partial nephrectomy.
Open vs. Laparoscopic Procedures
Compared to the open technique, here are some of the advantages of partial nephrectomy done through a keyhole procedure:
Better visualization during surgery thanks to magnification
Pain is reduced
Speedier recovery
Fewer days are needed in the hospital
There is less need for transfusions (rare with robotic partial nephrectomy)
Reduced chance of infection
Fewer incisional hernias (bulging of internal organs through the incision)
Can keep more kidney function
A 2020 review of studies found comparable success for cancer-specific survival (survival not influenced by other causes), disease-free survival (remaining free of cancer), and cancer recurrence for open or laparoscopic partial nephrectomies.
Both open and laparoscopic procedures are major surgeries. Follow your surgeon's recommendations before and after surgery to avoid postoperative complications.
Related: Life Expectancy After Kidney Removal
Partial Nephrectomy Post-Op and Recovery
After a laparoscopic partial nephrectomy, you will have to stay in the hospital for around two days. You will initially have a urinary catheter and a drain, both of which will be removed within a couple of days of surgery.
During the first postoperative day, you can begin eating light foods, especially soups and broths, and drinking plenty of liquids. You will be able to resume your usual diet after returning home.
While in the hospital, you'll receive your pain medication through an analgesic pump that allows you to control the level of medication you are comfortable with. Then, after you leave the hospital, you'll be given pain pills to take for a few days. After that, taking Tylenol (acetaminophen) is usually sufficient.
If you've had open surgery, recovery will be longer. You may need to stay in the hospital for up to one week. The wound may take up to three weeks to heal properly, and it could take two to three months to recover from the surgery.
During this time, you must avoid scrubbing your wound. It's also not uncommon to experience abdominal discomfort from deep tissues, as well as a temporary loss of sensation where nerves may have been cut. If you've had open surgery, you should also avoid strenuous activity for up to three months.
Your healthcare provider will give you instructions on showering and incision care at home. Don't take a tub bath until you've been cleared to do so (usually after your first follow-up appointment).
Talk to your healthcare provider about when you can resume driving.
You will likely be able to resume your activities within four to six weeks with a laparoscopic or robotic partial nephrectomy, while this will take between eight to 12 weeks with an open one. Talk to your healthcare provider about activity restrictions, such as avoiding lifting anything heavier than 10 pounds for six weeks.
Possible Complications
Specific complications noted in partial nephrectomy include:
Bleeding during or after surgery
Urinary fistula (urine leaking into the abdominal cavity rather than through the ureter)
Partial nephrectomy has risks of complications common to all major surgeries, such as a reaction to anesthesia, surgical wound infection, pneumonia (lung infection), blood clots, and urinary tract infection.
Contact your healthcare provider if you develop:
Fever
Shortness of breath
Swollen or tender calf or thigh
Blood in the urine
Pathology Results After Partial Nephrectomy
After partial kidney removal, one of your lingering concerns will likely be the pathology results of the tissue removed. It usually takes about one week for pathology results to come in. At that point, you will learn the status of any tumors removed, as well as any surrounding tissue and if any cancer cells were found.
Related: How Kidney Cancer Is Diagnosed and Staged
Follow-Up and Ongoing Care
Within about one month of surgery, you'll probably have to come back for a visit with your surgeon, as well as at the 12- and 24-month marks, to make sure the kidney continues to function and there are no signs of disease recurrence.
Summary
A partial kidney removal is a treatment option for some kidney tumors. It allows you to retain some kidney function. It may be done with a laparoscopic "keyhole" surgery, which may be robot-assisted, or an open surgery with a larger incision.
If a minimally invasive laparoscopic approach is taken, you may face fewer postoperative challenges and be able to leave the hospital sooner than you might with an open surgery. Whatever the approach, be prepared to return periodically to check your kidney function and ensure your condition is managed.
Related: What Is Radical Nephrectomy Surgery?
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