Difference between revisions of "Nephrectomy"
Josh Calvano (talk | contribs) (Described surgical nephrectomy categories and reason for surgery. Will continue to build out anesthetic considerations.) |
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{{Infobox surgical procedure | {{Infobox surgical procedure | ||
| anesthesia_type = | | anesthesia_type = General | ||
| airway = | | airway = ETT | ||
| lines_access = | | lines_access = Two large bore PIV, usually with a-line | ||
| monitors = | | monitors = Standard, +/- A-line | ||
| considerations_preoperative = | | considerations_preoperative = 2u pRBC on standby, usually EKG, CBC, CMP | ||
| considerations_intraoperative = | | considerations_intraoperative = Avoid nitrous (bowel expansion), avoid extremities with AV fistula, and avoid forearm veins for patients who may need future dialysis, avoid potassium containing fluids in patients with impaired renal function | ||
| considerations_postoperative = | | considerations_postoperative = hemorrhage, urinary fistula, UTI, DVT, wound infection, pleural effusion | ||
}} | }} | ||
| Line 29: | Line 29: | ||
|- | |- | ||
|Cardiovascular | |Cardiovascular | ||
|Renal hypertension | |Renal hypertension, assess for IVC thrombus, | ||
|- | |- | ||
| | |Pulmonary | ||
| | |Possible pulmonary mets if RCC | ||
|- | |- | ||
|Gastrointestinal | |Gastrointestinal | ||
| Line 41: | Line 41: | ||
|- | |- | ||
|Renal | |Renal | ||
| | |often CKD present | ||
|- | |- | ||
|Endocrine | |Endocrine | ||
| Line 51: | Line 51: | ||
===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ===Labs and studies<!-- Describe any important labs or studies. Include reasoning to justify the study and/or interpretation of results in the context of this procedure. If none, this section may be removed. -->=== | ||
Electrolytes, BUN, Cr. If indicated, perform additional workup for cardiac and pulmonary disease | Electrolytes, BUN, Cr. If indicated, perform additional workup for cardiac and pulmonary disease | ||
===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->=== | ===Operating room setup<!-- Describe any unique aspects of operating room preparation. Avoid excessively granular information. Use drug classes instead of specific drugs when appropriate. If none, this section may be removed. -->=== | ||
| Line 64: | Line 64: | ||
* Standard monitoring | * Standard monitoring | ||
*2 large bore IVs | |||
* Arterial line | * Arterial line | ||
* Consider central line if IVC or RA thrombus | * Consider central line if IVC or RA thrombus | ||
| Line 90: | Line 91: | ||
|+ | |+ | ||
! | ! | ||
! | !Simple | ||
! | !Open Radical | ||
|- | |- | ||
|Unique considerations | |Unique considerations | ||
| Line 98: | Line 99: | ||
|- | |- | ||
|Position | |Position | ||
| | |Flank or prone | ||
| | |Flank vs prone | ||
|- | |- | ||
|Surgical time | |Surgical time | ||
| Line 106: | Line 107: | ||
|- | |- | ||
|EBL | |EBL | ||
| | |500 | ||
| | |500 | ||
|- | |- | ||
|Postoperative disposition | |Postoperative disposition | ||
Latest revision as of 15:17, 25 September 2025
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
Two large bore PIV, usually with a-line |
| Monitors |
Standard, +/- A-line |
| Primary anesthetic considerations | |
| Preoperative |
2u pRBC on standby, usually EKG, CBC, CMP |
| Intraoperative |
Avoid nitrous (bowel expansion), avoid extremities with AV fistula, and avoid forearm veins for patients who may need future dialysis, avoid potassium containing fluids in patients with impaired renal function |
| Postoperative |
hemorrhage, urinary fistula, UTI, DVT, wound infection, pleural effusion |
| Article quality | |
| Editor rating | |
| User likes | 0 |
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[1][2].
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[3].
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[3]. 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
| System | Considerations |
|---|---|
| Neurologic | |
| Cardiovascular | Renal hypertension, assess for IVC thrombus, |
| Pulmonary | Possible pulmonary mets if RCC |
| Gastrointestinal | |
| Hematologic | |
| Renal | often CKD present |
| Endocrine | |
| Other |
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
- 2 large bore IVs
- 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
| Simple | Open Radical | |
|---|---|---|
| Unique considerations | ||
| Position | Flank or prone | Flank vs prone |
| Surgical time | ||
| EBL | 500 | 500 |
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
- ↑ "Nephrectomy". www.nephrologyspecialistsoftulsa.com. Retrieved 2022-02-02.
- ↑ "Simple Nephrectomy". urology-textbook.com. Retrieved 2022-02-02.
- ↑ 3.0 3.1 Anesthesiologist's manual of surgical procedures. Richard A. Jaffe, Clifford A. Schmiesing, Brenda Golianu (Sixth edition ed.). Philadelphia. 2020. ISBN 978-1-4698-2916-6. OCLC 1117874404.
|edition=has extra text (help)CS1 maint: others (link)