wikipedia - nephrectomy (checked)

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18/04/15 ephrectomy - Wikipedia, the free encyclopedia

Pgina ttp://en.wikipedia.org/wiki/Nephrectomy

Nephrectomy

Intervention

Before and after a radical nephrectomy

ICD-9-

CM

55.5 (http://icd9cm.chrisendres.com/index.php?

srchtype=procs&srchtext=55.5&Submit=Search&action=sear

MeSH D009392

OPS-

301 code:

5-554 (http://ops.icd-code.de/ops/code/5-554.html)

Partial Nephrectomy

Intervention

NephrectomyFrom Wikipedia, the free encyclopedia

Nephrectomyis the surgical removal of

a kidney. See below for partial

nephrectomy.

Contents

1 History

2 Indications

3Procedure

4After care

5 Partial Nephrectomy5.1 History

5.2 Indications

5.3 Procedure

5.4 Complications

5.5 Cancer Control,

Quality of Life and

Survival

6 See also

7References

8 Links and Sources

History

The first successful nephrectomy was

performed by the German surgeonGustav Simon on August 2, 1869 in

Heidelberg. Simon practiced the

operation beforehand in animal

experiments. He proved that one healthy

kidney can be sufficient for urine

excretion in humans.

Indications
http://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_radical_nephrectomy_CRUK_104.svghttp://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_radical_nephrectomy_CRUK_104.svghttp://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_radical_nephrectomy_CRUK_104.svghttp://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_radical_nephrectomy_CRUK_104.svghttp://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_radical_nephrectomy_CRUK_104.svghttp://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_radical_nephrectomy_CRUK_104.svghttp://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_radical_nephrectomy_CRUK_104.svghttp://en.wikipedia.org/wiki/Nephrectomy#Links_and_Sourceshttp://en.wikipedia.org/wiki/Nephrectomy#Referenceshttp://en.wikipedia.org/wiki/Nephrectomy#Cancer_Control.2C_Quality_of_Life_and_Survivalhttp://en.wikipedia.org/wiki/Nephrectomy#Cancer_Control.2C_Quality_of_Life_and_Survivalhttp://en.wikipedia.org/wiki/Nephrectomy#Complicationshttp://en.wikipedia.org/wiki/Nephrectomy#History_2http://en.wikipedia.org/wiki/Nephrectomy#Partial_Nephrectomyhttp://en.wikipedia.org/wiki/Nephrectomy#After_carehttp://en.wikipedia.org/wiki/Nephrectomy#Historyhttp://en.wikipedia.org/wiki/Nephrectomy#Partial_Nephrectomyhttp://en.wikipedia.org/wiki/Heidelberghttp://en.wikipedia.org/wiki/Gustav_Simon_(physician)http://en.wikipedia.org/wiki/Nephrectomy#Links_and_Sourceshttp://en.wikipedia.org/wiki/Nephrectomy#Referenceshttp://en.wikipedia.org/wiki/Nephrectomy#See_alsohttp://en.wikipedia.org/wiki/Nephrectomy#Cancer_Control.2C_Quality_of_Life_and_Survivalhttp://en.wikipedia.org/wiki/Nephrectomy#Complicationshttp://en.wikipedia.org/wiki/Nephrectomy#Procedure_2http://en.wikipedia.org/wiki/Nephrectomy#Indications_2http://en.wikipedia.org/wiki/Nephrectomy#History_2http://en.wikipedia.org/wiki/Nephrectomy#Partial_Nephrectomyhttp://en.wikipedia.org/wiki/Nephrectomy#After_carehttp://en.wikipedia.org/wiki/Nephrectomy#Procedurehttp://en.wikipedia.org/wiki/Nephrectomy#Indicationshttp://en.wikipedia.org/wiki/Nephrectomy#Historyhttp://en.wikipedia.org/wiki/Nephrectomy#Partial_Nephrectomyhttp://en.wikipedia.org/wiki/Kidneyhttp://ops.icd-code.de/ops/code/5-554.htmlhttp://en.wikipedia.org/wiki/OPS-301http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D009392http://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://icd9cm.chrisendres.com/index.php?srchtype=procs&srchtext=55.5&Submit=Search&action=searchhttp://en.wikipedia.org/wiki/ICD-9-CM_Volume_3http://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_radical_nephrectomy_CRUK_104.svg


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Before and after a partial nephrectomy

ICD-9-

CM

55.4 (http://icd9cm.chrisendres.com/index.php?

srchtype=procs&srchtext=55.4&Submit=Search&action=sear

MeSH D009392

OPS-

301 code:

5-554 (http://ops.icd-code.de/ops/code/5-554.html)

Laparoscopic nephrectomy

There are various indications for this

procedure, such as renal cell carcinoma,

a non-functioning kidney (which may

cause high blood pressure) and a

congenitally small kidney (in which the

kidney is swelling, causing it to press on

nerves which can cause pain in unrelated

areas such as the back). Nephrectomy forrenal cell carcinoma is rapidly being

modified to allow partial removal of the

kidney. Nephrectomy is also performed

for the purpose of living donor kidney

ransplantation. A nephroureterectomy is

he removal of a kidney and the entire

ureter and a small cuff of the bladder for

urothelial cancer of the kidney or ureter.

Procedure

The surgery is performed with the patient under general anesthesia. A

kidney can be removed through an open incision or laparoscopically.

For the open procedure, the surgeon makes an incision in the side of

abdomen to reach the kidney. Depending on circumstances, the incisi

can also be made midline. The ureter and blood vessels are

disconnected, and the kidney is then removed. The laparoscopic

approach utilizes three or four small (510 mm) cuts in the abdomina

and flank area. The kidney is completely detached inside the body an

then placed in a bag. One of the incisions is then expanded to remove

the kidney for cancer operations. If the kidney is being removed for

other causes, it can be morcellated and removed through the small incisions. Recently, this procedure is

performed through a single incision in the patient's belly-button. This advanced technique is called single por

aparoscopy.

n January 2009, a woman who had previously had a hysterectomy was able to donate a kidney and have it

removed through her vagina. The operation took place at Johns Hopkins Medical Center. This is the first tim

healthy kidney has been removed via this method, though it has been done in the past for nephrectomies carr

out due to pathology. Removing organs through orifices prevents some of the pain of an incision and the nee
http://en.wikipedia.org/wiki/Pathologyhttp://en.wikipedia.org/wiki/Johns_Hopkins_Hospitalhttp://en.wikipedia.org/wiki/Hysterectomyhttp://en.wikipedia.org/wiki/Single_port_laparoscopyhttp://en.wikipedia.org/wiki/Ureterhttp://en.wikipedia.org/wiki/Midlinehttp://en.wikipedia.org/wiki/Abdomenhttp://en.wikipedia.org/wiki/Laparoscopic_Surgeryhttp://en.wikipedia.org/wiki/General_anesthesiahttp://en.wikipedia.org/w/index.php?title=Urothelial_cancer&action=edit&redlink=1http://en.wikipedia.org/wiki/Kidney_transplantationhttp://en.wikipedia.org/wiki/Organ_donationhttp://en.wikipedia.org/wiki/Arterial_hypertensionhttp://en.wikipedia.org/wiki/Renal_cell_carcinomahttp://en.wikipedia.org/wiki/File:Diagram_showing_laparoscopic_surgery_for_kidney_cancer_CRUK_165.svghttp://ops.icd-code.de/ops/code/5-554.htmlhttp://en.wikipedia.org/wiki/OPS-301http://www.nlm.nih.gov/cgi/mesh/2011/MB_cgi?field=uid&term=D009392http://en.wikipedia.org/wiki/Medical_Subject_Headingshttp://icd9cm.chrisendres.com/index.php?srchtype=procs&srchtext=55.4&Submit=Search&action=searchhttp://en.wikipedia.org/wiki/ICD-9-CM_Volume_3http://en.wikipedia.org/wiki/File:Diagram_showing_before_and_after_a_partial_nephrectomy_CRUK_102.svg


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for a cosmetically unappealing larger scar. Any advance which leads to a decrease in pain and scarring has th

potential to boost donor numbers.[1]This operation also has taken place at the Cleveland Clinic. The first

ransvaginal Nephrectomy actually took place at the Cleveland Clinic in Cleveland Ohio.[2]

For some illnesses, there are alternatives today that do not require the extraction of a kidney. Such alternative

nclude renal embolization[3]for those who are poor candidates for surgery, or partial nephrectomy if possibl

Occasionally renal cell cancers can involve adjacent organs, including the IVC, the colon, the pancreas or theiver. If the cancer has not spread to distant sites, it may be safely and completely removed surgically via ope

or laparoscopic techniques.[4]

After care

Pain medication is often given to the patient after the surgery because of pain at the site of the incision. An IV

with fluids is administered. Electrolyte balance and fluids are carefully monitored, because these are the

functions of the kidneys. It is possible that the remaining kidney does not take over all functionality. A patien

has to stay in the hospital between 2 and 7 days depending on the procedure and complications.

Partial Nephrectomy

Partial Nephrectomyis the surgical removal of a kidney tumor along with a thin rim of normal kidney, with

he two aims of curing the cancer and preserving as much normal kidney as possible.

History

Czerny first described a partial nephrectomy in 1890.[5]However, due to limited x-ray and imaging capabilito find small kidney tumors and significant complications associated with early operations it was largely

abandoned. More recently, with improved imaging, improved surgical techniques and increased kidney tumo

detection, partial nephrectomy is performed more often.[6]

Indications

A partial nephrectomy should be attempted when there is a kidney tumor in a solitary kidney, when there are

kidney tumors in both kidneys, or when removing the entire kidney could result in kidney failure and the nee

for dialysis.

Partial Nephrectomy is also the standard of care for nearly all patients with small renal masses (


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Procedure

A partial nephrectomy is performed with a patient under general anesthesia as well. A partial nephrectomy ca

be performed through an open, laparoscopic[9]or robotic approach. The patient is typically placed on the

operating room bed lying on the side opposite the kidney tumor. The goal of the procedure is to remove the

kidney tumor along with a thin rim of normal kidney tissue. Because the kidneys clean the blood, all blood

eventually flows through the kidneys and 25% of it will go into the kidneys with each heart beat. In order to

safely remove the kidney tumor, the blood flow to the kidney is often temporarily blocked off. The tumor is tcut out and the surgeon must sew the remaining kidney back together. Partial nephrectomy is often an

alternative to complete or radical nephrectomy for renal cell cancer.

Complications

Patients who undergo partial nephrectomy experience complications around 15-25% of the time.[9][10]The m

common complications are bleeding, infection and urinary leak.[9]

Cancer Control, Quality of Life and Survival

Partial nephrectomy offers the same chance of cure from the renal cell cancer as radical nephrectomy.[6][7]T

was confirmed in a recent meta-analysis.[11]Partial nephrectomy has been shown to maintain kidney functio

better than total removal.[7]There is some debate whether this preservation of kidney function leads to long-

erm benefits to the patient.[12]Some studies have found that patients treated by partial nephrectomy live lon

han patients who had their whole kidney removed.[7]Other studies have found the opposite.[13]Partial

nephrectomy has been associated with better quality of life compared to radical nephrectomy.[14]

See also

Kidney donation

References

1. Donor kidney removed via vagina (http://news.bbc.co.uk/1/hi/health/7867837.stm), BBC News, 3 February 2009

2. "Cleveland Clinic performs first transvaginal kidney removal, plans a second"

(http://blog.cleveland.com/medical/2009/03/cleveland_clinic_performs_firs.html). The Plain Dealer. March 30, 2009

|first1=missing |last1=in Authors list (help)

3. Hom, David; Eiley, David; Lumerman, Jeffrey H.; Siegel, David N.; Goldfischer, Evan R.; Smith, Arthur D. (1999).

"Complete Renal Embolization As an Alternative to Nephrectomy". The Journal of Urology161(1): 247.

doi:10.1016/S0022-5347(01)62049-4 (https://dx.doi.org/10.1016%2FS0022-5347%2801%2962049-4). PMID 10037

(https://www.ncbi.nlm.nih.gov/pubmed/10037359).

4. Crotty, KL; MacAluso Jr, JN (2000). "Partial colectomy required for resection of renal cell carcinoma: A case report
http://www.ncbi.nlm.nih.gov/pubmed/10037359http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1016%2FS0022-5347%2801%2962049-4http://en.wikipedia.org/wiki/Digital_object_identifierhttp://en.wikipedia.org/wiki/Help:CS1_errors#first_missing_lasthttp://blog.cleveland.com/medical/2009/03/cleveland_clinic_performs_firs.htmlhttp://news.bbc.co.uk/1/hi/health/7867837.stmhttp://en.wikipedia.org/wiki/Kidney_donationhttp://en.wikipedia.org/wiki/Nephrectomy#cite_note-QOL-14http://en.wikipedia.org/wiki/Quality_of_lifehttp://en.wikipedia.org/wiki/Nephrectomy#cite_note-EORTC-13http://en.wikipedia.org/wiki/Nephrectomy#cite_note-pn_vs_rn_weight-7http://en.wikipedia.org/wiki/Nephrectomy#cite_note-juror_editorial-12http://en.wikipedia.org/wiki/Nephrectomy#cite_note-pn_vs_rn_weight-7http://en.wikipedia.org/wiki/Nephrectomy#cite_note-simon_meta-11http://en.wikipedia.org/wiki/Meta-analysishttp://en.wikipedia.org/wiki/Nephrectomy#cite_note-pn_vs_rn_weight-7http://en.wikipedia.org/wiki/Nephrectomy#cite_note-AUA_Guidelines-6http://en.wikipedia.org/wiki/Nephrectomy#cite_note-eighteen-9http://en.wikipedia.org/wiki/Nephrectomy#cite_note-simon_complications-10http://en.wikipedia.org/wiki/Nephrectomy#cite_note-eighteen-9http://en.wikipedia.org/wiki/Renal_cell_cancerhttp://en.wikipedia.org/wiki/Robotic_Surgeryhttp://en.wikipedia.org/wiki/Nephrectomy#cite_note-eighteen-9http://en.wikipedia.org/wiki/Laparoscopic_Surgeryhttp://en.wikipedia.org/wiki/Open_surgery


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review of treatment options for locally advanced disease". The Journal of the Louisiana State Medical Society152(3

11923. PMID 10851826 (https://www.ncbi.nlm.nih.gov/pubmed/10851826).

5. Czerny HE (cited by Herczel E): Ueber nierenextirpation bietr. Klin Khirurg 1890;6:485.

6. Campbell, Steven C.; Novick, Andrew C.; Belldegrun, Arie; Blute, Michael L.; Chow, George K.; Derweesh, Ithaar

Faraday, Martha M.; Kaouk, Jihad H.; Leveillee, Raymond J.; Matin, Surena F.; Russo, Paul; Uzzo, Robert G.; Practi

Guidelines Committee of the American Urological Association (2009). "Guideline for Management of the Clinical T

Renal Mass". The Journal of Urology182(4): 12719. doi:10.1016/j.juro.2009.07.004

(https://dx.doi.org/10.1016%2Fj.juro.2009.07.004). PMID 19683266 (https://www.ncbi.nlm.nih.gov/pubmed/196832

7. Weight, Christopher J.; Larson, Benjamin T.; Fergany, Amr F.; Gao, Tianming; Lane, Brian R.; Campbell, Steven C.;

Kaouk, Jihad H.; Klein, Eric A.; Novick, Andrew C. (2010). "Nephrectomy Induced Chronic Renal Insufficiency is

Associated with Increased Risk of Cardiovascular Death and Death from Any Cause in Patients with Localized cT1b

Renal Masses". The Journal of Urology183(4): 131723. doi:10.1016/j.juro.2009.12.030


8. Weight, Christopher J.; Crispen, Paul L.; Breau, Rodney H.; Kim, Simon P.; Lohse, Christine M.; Boorjian, Stephen

Thompson, R. Houston; Leibovich, Bradley C. (2013). "Practice-setting and surgeon characteristics heavily influence

decision to perform partial nephrectomy among American Urologic Association surgeons".BJU International111(5

7318. doi:10.1111/j.1464-410X.2012.11112.x (https://dx.doi.org/10.1111%2Fj.1464-410X.2012.11112.x).

PMID 22502641 (https://www.ncbi.nlm.nih.gov/pubmed/22502641).

9. Gill, Inderbir S.; Kavoussi, Louis R.; Lane, Brian R.; Blute, Michael L.; Babineau, Denise; Colombo Jr, J. Roberto;

Frank, Igor; Permpongkosol, Sompol; Weight, Christopher J.; Kaouk, Jihad H.; Kattan, Michael W.; Novick, Andrew

(2007). "Comparison of 1,800 Laparoscopic and Open Partial Nephrectomies for Single Renal Tumors". The Journa

Urology178(1): 416. doi:10.1016/j.juro.2007.03.038 (https://dx.doi.org/10.1016%2Fj.juro.2007.03.038).


10. Kim, Simon P.; Leibovich, Bradley C.; Shah, Nilay D.; Weight, Christopher J.; Borah, Bijan J.; Han, Leona C.; Boorj

Stephen A.; Thompson, R. Houston (2013). "The relationship of postoperative complications with in-hospital outcom

and costs after renal surgery for kidney cancer".BJU International111(4): 5808. doi:10.1111/j.1464-

410X.2012.11122.x (https://dx.doi.org/10.1111%2Fj.1464-410X.2012.11122.x). PMID 22564425


11. Kim, Simon P.; Murad, M. Hassan; Thompson, R. Houston; Boorjian, Stephen A.; Weight, Christopher J.; Han, Leon

C.; Erwin, Patricia J.; Costello, Brian A.; Chow, George K.; Leibovich, Bradley C. (2012). "Comparative Effectivene

for Survival and Renal Function of Partial and Radical Nephrectomy for Localized Renal Tumors: A Systematic Rev

and Meta-Analysis". The Journal of Urology. doi:10.1016/j.juro.2012.10.026

(https://dx.doi.org/10.1016%2Fj.juro.2012.10.026).

12. Weight, Christopher J.; Miller, David C.; Campbell, Steven C.; Derweesh, Ithaar H.; Lane, Brian R.; Messing, Edwar

M. (2013). "The Management of a Clinical T1b Renal Tumor in the Presence of a Normal Contralateral Kidney". Th

Journal of Urology189(4): 1198202. doi:10.1016/j.juro.2013.01.030


13. Van Poppel, Hendrik; Da Pozzo, Luigi; Albrecht, Walter; Matveev, Vsevolod; Bono, Aldo; Borkowski, Andrzej;

Colombel, Marc; Klotz, Laurence; Skinner, Eila; Keane, Thomas; Marreaud, Sandrine; Collette, Sandra; Sylvester,

Richard (2011). "A Prospective, Randomised EORTC Intergroup Phase 3 Study Comparing the Oncologic Outcome
http://www.ncbi.nlm.nih.gov/pubmed/23337186http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1016%2Fj.juro.2013.01.030http://en.wikipedia.org/wiki/Digital_object_identifierhttp://dx.doi.org/10.1016%2Fj.juro.2012.10.026http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/22564425http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1111%2Fj.1464-410X.2012.11122.xhttp://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/17574056http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1016%2Fj.juro.2007.03.038http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/22502641http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1111%2Fj.1464-410X.2012.11112.xhttp://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/20171688http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1016%2Fj.juro.2009.12.030http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/19683266http://en.wikipedia.org/wiki/PubMed_Identifierhttp://dx.doi.org/10.1016%2Fj.juro.2009.07.004http://en.wikipedia.org/wiki/Digital_object_identifierhttp://www.ncbi.nlm.nih.gov/pubmed/10851826http://en.wikipedia.org/wiki/PubMed_Identifier


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Elective Nephron-Sparing Surgery and Radical Nephrectomy for Low-Stage Renal Cell Carcinoma".European Urol

59(4): 54352. doi:10.1016/j.eururo.2010.12.013 (https://dx.doi.org/10.1016%2Fj.eururo.2010.12.013).


14. Clark, Peter E; Schover, Leslie R; Uzzo, Robert G; Hafez, Khaled S; Rybicki, Lisa A; Novick, Andrew C (2001).

"Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: Impact of the

amount of remaining renal tissue". Urology57(2): 2526. doi:10.1016/S0090-4295(00)00927-4

(https://dx.doi.org/10.1016%2FS0090-4295%2800%2900927-4). PMID 11182331


Links and Sources

Drawings of the steps of the procedure

(http://www.nlm.nih.gov/medlineplus/ency/presentations/100069_1.htm)

MedlinePlus Medical Encyclopedia: Nephrectomy

(http://www.nlm.nih.gov/medlineplus/ency/article/003001.htm)

Explanation of the surgery, the risks and the recovery

(http://www.surgerydoor.co.uk/advice/operations/nephrectomy-kidney-removal/?locale=en)

Retrieved from "http://en.wikipedia.org/w/index.php?title=Nephrectomy&oldid=640673547"

Categories: Surgical oncology Surgical removal procedures Urologic surgery

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