Nephrectomy

2022-02-02T23:30:28Z

Josh Calvano: Described surgical nephrectomy categories and reason for surgery. Will continue to build out anesthetic considerations.

{{Infobox surgical procedure
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There are three categories for nephrectomies, depending on the extent of surgical involvement, these include: simple, partial, and radical nephrectomy.

A '''simple nephrectomy''' refers to the surgical removal of the affected kidney and small segment of the proximal ureter. Diagnoses warranting this procedure can include benign conditions, such as: hematuria, recurrent urinary tract infections, nephrolithiasis, hydronephrosis, flank pain, or kidney donation<ref>{{Cite web|title=Nephrectomy|url=https://www.nephrologyspecialistsoftulsa.com/nephrectomy.php|access-date=2022-02-02|website=www.nephrologyspecialistsoftulsa.com}}</ref><ref>{{Cite web|title=Simple Nephrectomy|url=http://urology-textbook.com/simple-nephrectomy.html|access-date=2022-02-02|website=urology-textbook.com}}</ref>.

A '''partial nephrectomy''' refers to the surgical removal of the pathologic portion of the kidney. Diagnoses warranting this procedure can include: chronic hydronephrosis, hypoplastic kidney, renovascular hypertension, or a double collecting system<ref name=":0">{{Cite book|url=https://www.worldcat.org/oclc/1117874404|title=Anesthesiologist's manual of surgical procedures|date=2020|others=Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu|isbn=978-1-4698-2916-6|edition=Sixth edition|location=Philadelphia|oclc=1117874404}}</ref>.

A '''radical nephrectomy''' refers to the surgical removal of the affected kidney, with surrounding perinephric fat, Gerota's fascia, proximal 2/3 of the ureter, and can additionally include paracaval or para-aortic lymphadenectomy<ref name=":0" />. Diagnoses warranting this procedure are usually renal cell carcinoma or a double collecting system. Of note, if there is tumor or thrombus involving the vena cava or right atrium an interprofessional team involving cardiac surgery may also be involved.

== Preoperative management==

=== Patient evaluation===
{| class="wikitable"
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!System
! Considerations
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|Neurologic
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|Cardiovascular
|Renal hypertension
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|Respiratory
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|Gastrointestinal
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|Hematologic
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|Renal
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|Endocrine
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|Other
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===Labs and studies===
Electrolytes, BUN, Cr. If indicated, perform additional workup for cardiac and pulmonary disease.

===Operating room setup===

===Patient preparation and premedication===

===Regional and neuraxial techniques===

==Intraoperative management ==

===Monitoring and access===

* Standard monitoring
* Arterial line
* Consider central line if IVC or RA thrombus

===Induction and airway management===

* Standard induction

===Positioning===

===Maintenance and surgical considerations===

===Emergence===

==Postoperative management==

===Disposition===

===Pain management===

===Potential complications===

==Procedure variants==

{| class="wikitable wikitable-horizontal-scroll"
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!
!Variant 1
!Variant 2
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|Unique considerations
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|Position
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|Surgical time
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|EBL
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|Postoperative disposition
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|Pain management
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|Potential complications
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==References==

[[Category:Surgical procedures]]
<references />

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Nephrectomy