50340 Recipient nephrectomy (separate procedure)

Name of the Procedure:

Recipient nephrectomy (separate procedure) Commonly referred to as a kidney removal surgery for transplant recipients.

Summary

A recipient nephrectomy is a surgical procedure to remove one or both diseased kidneys from a patient who is about to receive a kidney transplant or has received a transplant.

Purpose

The primary purpose is to remove a dysfunctional or diseased kidney that may cause complications during or following a kidney transplant. Goals include reducing the risk of infection, hypertension, and other kidney-related health issues, and improving the overall success rate of the kidney transplant.

Indications

• Chronic kidney disease or renal failure
• Polycystic kidney disease
• Recurrent kidney infections
• High blood pressure due to kidney dysfunction
• Kidney cancer in transplant candidates
• Non-functioning transplanted kidney causing complications

Preparation

• Fasting for at least 8 hours before the procedure
• Adjusting or stopping certain medications, as advised by the healthcare provider
• Preoperative blood tests, imaging studies (e.g., CT scan, ultrasound), and sometimes a kidney biopsy to assess the condition of the kidneys
• Meeting with an anesthesiologist for preoperative clearance

Procedure Description

1. Anesthesia: The patient is given general anesthesia for a pain-free experience.
2. Incision: A surgical incision is made, usually on the side or lower abdomen.
3. Access: The surgeon carefully separates surrounding tissues to access the kidney.
4. Removal: The blood vessels and ureter connected to the kidney are clamped and cut, facilitating the removal of the kidney.
5. Closing: The incision is closed using sutures or staples, and a drainage tube may be placed to remove excess fluids.

Specialized surgical instruments and imaging technology may be used to ensure precision.

Duration

Typically, the procedure takes about 2 to 3 hours, but this may vary based on the patient's condition.

Setting

It is performed in a hospital operating room under sterile conditions.

Personnel

• Lead surgeon specialized in nephrectomy
• Surgical assistants
• Anesthesiologist
• Scrub nurses and circulating nurses

Risks and Complications

• Infection at the surgical site
• Bleeding and blood clots
• Injury to adjacent organs
• Anesthesia-related complications
• Postoperative pain
• Potential need for dialysis if complications arise

Benefits

• Elimination of diseased kidney(s) to minimize health risks
• Increased likelihood of a successful kidney transplantation
• Potential for improved overall kidney function and quality of life post-transplant

Recovery

• Hospital stay for a few days post-surgery
• Pain management with medications
• Instructions for incision care and avoiding strenuous activities
• Follow-up appointments to monitor healing and kidney function
• Potential temporary dietary restrictions

Alternatives

• Conservative management with medications in cases where possible
• Dialysis in lieu of kidney removal, though often a temporary or less optimal solution
• Less invasive procedures for specific conditions, though not always applicable

Pros and Cons of Alternatives:

• Medications can manage symptoms but may not address the underlying problem.
• Dialysis supports kidney function but can impact the patient’s quality of life and is often temporary.

Patient Experience

During the procedure, the patient is under general anesthesia and will not feel any pain. Postoperatively, patients will experience some pain and discomfort, which can be managed with medications. Most patients can expect to return to their normal activities within 4-6 weeks, with some restrictions on heavy lifting and strenuous activities. Pain and discomfort will gradually decrease as healing progresses.