September 30, 2010 · Leave a Comment
The surgical removal of a kidney (partial or total).
- A nephrectomy may be performed for many reasons, including hydronephrosis, pyelonephritis, renal atrophy, renal artery stenosis, trauma, and tumors of the kidney and uterus.
- If a major portion of the ureter is also excised, the procedure is termed a Nephroureterectomy.
- Lateral lumbar frank or transthoracic with affected side up.
- Flank (posterior axillary line, beneath the twelfth rib to suprapubic area).
- Laparotomy pack with transverse Lap sheet
- Extra drape sheets
- Major procedure tray
- Kidney tray
- Thoracotomy tray with vascular clamps
- Internal stapling instruments
- Positioning aids
- Basin set
- Needle counter
- Asepto syringe
- Dissector sponges
- Penrose drains
- Closed-wound drainage
- Chest tube and drainage unit
- Suprapubic catheter
- A curved incision is made across the flank, and the fascia and muscle tissues are divided with a dissecting scissors or cautery.
- Occasionally a rib must be sacrificed to gain access to the retroperitoneal space.
- If a rib is to be taken, periosteal elevators and rib shears should be available.
- The kidney and ureters are mobilized. The ureter is divided and the distal end ligated.
- For malignant disease, a radical nephrectomy is performed. On the right side, the duodenum is protected with moist Lap sponges.
- The vascular pedicle is transected and lymph node-bearing tissue is excised.
- Gerota’s fascia is dissected from surrounding tissue; the ureter is divided and the kidney and surrounding fat, adrenal gland, and fascia are removed en bloc.
- If a flank incision is being used, a second lower flank or inguinal incision is used to expose the distal ureter extraperitoneally.
- The distal ureter is dissected free of surrounding tissues and a small cuff or bladder is excised with the intramural portion of the ureter.
- The bladder incision is repaired; a suprapubic cystostomy catheter may be placed, and the distal ureter and bladder cuff are delivered into the flank wound and removed with the kidney.
- The flank incision may be closed with or without drainage, in separate layers.
- For trauma and some presentations of calculus disease involving only a portion of the kidney, a partial nephrectomy may be performed.
Perioperative Nursing Considerations
- The surgeon or anesthesiologist may request hypothermia measured during the procedure.
- Have all X-rays in the room.
- Verify with the blood bank the number of available units.
- Chest tube and drainage unit will be needed for a transthoracic approach.
- A suprapubic catheter and drainage unit may be used if nephroureterectomy is performed.
- When two incisions are used, the patient is repositioned. Additional instrument tray is necessary.