Nephrectomy

Nephrectomy

Anesthesia type
Airway
Lines and access
Monitors
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
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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.

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.

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. 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
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Labs and studies

Electrolytes, BUN, Cr. If indicated, perform additional workup for cardiac and pulmonary disease.

Intraoperative management

Monitoring and access

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

Induction and airway management

• Standard induction

Procedure variants

	Variant 1	Variant 2
Unique considerations
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications