Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy
CPT4 code
Name of the Procedure:
Nephrectomy with Partial Ureterectomy, Open Approach
Technical term: Radical nephrectomy with regional lymphadenectomy and/or vena caval thrombectomy, including rib resection.
Summary
A nephrectomy involves the surgical removal of a kidney. In this procedure, part of the ureter (the tube that carries urine from the kidney to the bladder) is also removed. The operation employs an open approach, which includes making a sizeable incision in the abdomen or side, and in some cases, a rib may be removed for better access. Additionally, regional lymph nodes and any tumors or obstruction in the vena cava (the large vein that carries blood to the heart) may be excised.
Purpose
The procedure addresses severe kidney conditions such as advanced kidney cancer or other significant renal diseases. The goals are to completely remove the diseased kidney and associated structures, control or remove cancer spread, and alleviate symptoms related to the diseased kidney.
Indications
- Kidney cancer (renal cell carcinoma) that's localized or locally advanced.
- Non-functional kidneys causing symptoms or infection.
- Large kidney tumors obstructing blood flow.
- Specific genetic conditions or syndromes.
- Severe trauma to the kidney.
Preparation
- Fasting for at least 8 hours before the procedure.
- Adjustments to current medications as directed by the healthcare provider.
- Preoperative tests such as blood tests, imaging (CT scan, MRI), and possibly an EKG.
- Patients may need to stop taking blood-thinning medications days before surgery.
Procedure Description
- Receive general anesthesia.
- An incision is made in the abdomen or side to access the kidney.
- Removal of the affected kidney along with part of the ureter.
- If necessary, a rib may be removed for better access.
- Regional lymph nodes are examined and possibly removed.
- If a tumor is present in the vena cava, it is excised.
- The operative field is closed with sutures or staples.
- A drain may be placed to prevent fluid accumulation.
Duration
Typically, 3-4 hours, depending on the complexity of the case.
Setting
The procedure is performed in a hospital's surgical unit.
Personnel
- Lead surgeon (urologist)
- Assistant surgeons
- Anesthesiologist
- Operating room nurses
- Surgical technologists
Risks and Complications
- Common risks: Bleeding, infection, pain, and reaction to anesthesia.
- Rare risks: Damage to surrounding organs, deep vein thrombosis, pulmonary embolism, and complications related to vena caval thrombectomy.
Benefits
- Potentially curative for localized kidney cancer.
- Relief from symptoms and reduction in future health risks.
- Improvement in overall quality of life post-recovery.
Recovery
- Hospital stay of about 5-7 days post-surgery.
- Instructions on wound care and movement restrictions.
- Pain management with medications.
- Gradual return to normal activities within 6-8 weeks.
- Follow-up appointments for monitoring recovery and any adjunct treatments like chemotherapy.
Alternatives
- Minimally invasive procedures like laparoscopic or robotic nephrectomy.
- Partial nephrectomy if only part of the kidney is affected.
- Ablative therapies (radiofrequency or cryoablation) for localized tumors.
- Active surveillance in cases of small, non-aggressive tumors.
- Conservative management and palliative care for non-operable cases.
Patient Experience
Patients are expected to feel sore post-surgery but will have pain management strategies in place. Initial discomfort will be managed with medications and physical support from healthcare providers. Gradual improvements in energy levels and overall well-being are expected within several weeks after surgery.