What is Transperitoneal nephrectomy?
Transperitoneal nephrectomy is the surgical removal of the kidney.

Nephrectomy is the surgical removal of the kidney. The transperitoneal approach of a kidney is the incision through the peritoneum (the tissue that lines the abdominal cavity and covers most of the abdominal organs) with the most direct access to the interspace between the common iliac vessels (large blood vessels in the abdomen).

The transperitoneal approach has the benefit of being a fairly familiar technique with immediately recognized anatomy and a significantly bigger working surface.

Nephrectomy can be either a partial nephrectomy often done to remove the cancerous part of the kidney or a complete nephrectomy done to remove the cancerous kidney or a healthy kidney for transplantation.

How is transperitoneal nephrectomy done?

A midline incision is often preferred by some surgeons, whereas anterior subcostal, thoracoabdominal, and flank approaches are favored in others. Most tumors can be removed with a transperitoneal subcostal (under the lower border of the ribs) incision.

Transperitoneal subcostal incision nephrectomy

In people with particularly big tumors of the right kidney, a right subcostal incision under general anesthesia with a transperitoneal approach is used for radical nephrectomy. This method provides improved access to the renal pedicle and major vessels of the region, as well as improved exposure to the abdominal cavity organs.

  • The ureter (the tube that transports urine from the kidney to the bladder) and blood vessels around the kidney are cut and clipped, and the kidney is removed.
  • The incision is then sealed using stitches.

This method may be more beneficial in circumstances when liver involvement is suspected.

Transperitoneal laparoscopic nephrectomy

  • A transperitoneal laparoscopic nephrectomy is performed using a laparoscope (a thin, flexible tube with a camera and light source). 
  • After appropriate anesthesia is given, a small needle is inserted into the peritoneum, and gas is sent to create a pneumoperitoneum. This helps create a wider working space for the surgeon.
  • Instruments are inserted through small incisions.
  • The renal artery and vein are cut open, examined, and clipped individually.
  • The peduncle of the kidney is cut, and the kidney is removed from the body.
  • If the tumor is present, it is removed completely with safe margins.
  • Bleeding through vessels is stopped, an incision is sealed with stitches, and a drain is placed at the surgical site.
  • For pain management, an analgesia pump and acetaminophen are used.

QUESTION

The only purpose of the kidneys is to filter blood. See Answer

What is the advantage of transperitoneal nephrectomy?

The main advantage of the abdominal approach is that it provides great exposure in the region of the renal pedicle (the part of the kidney where its blood vessels, nerves, and ureters pass).

  • A vertical midline incision is less difficult and faster to conduct. It enables easier viewing of the remaining abdominal contents.
  • A transverse incision allows for greater access to the lateral and superior portions of the kidney, whereas a unilateral subcostal incision can be prolonged across the midline as a chevron incision to offer excellent exposure to both kidneys, aorta, and inferior vena cava. 

The main drawback of the abdominal route is the somewhat prolonged postoperative ileus and intraabdominal adhesions.

What are the complications of nephrectomy?

Every procedure includes risks and complications. The following are some of the risks associated with nephrectomy surgery:

In addition, there is a slight risk of renal failure in a person with impaired function or illness in the remaining kidney.

Complications in a kidney donor who underwent nephrectomy are minimum. This is most likely because practically all living donors are subjected to extensive pre-op testing and assessment to ensure they are healthy enough for surgery.

Most studies report donor nephrectomy fatality rates of 1 or 2 per 10,000 donor procedures. Postoperative wound infection or complication may occur in 1 or 2 out of every 100 people, with about half of these people requiring reoperation for a problem.

The majority of kidney donors enjoy long and healthy lives even with one kidney.

What is the aftercare following nephrectomy?

Your healthcare team will closely monitor your blood pressure, electrolytes, and fluid balance immediately following surgery. The kidneys are in charge of several of these bodily tasks. During your recuperation, you will most likely have a urinary catheter (a tube that drains urine) in your bladder.

Depending on the technique of operation, you will most likely be in the hospital for one to seven days. You will be urged to resume mild activities as soon as you are able. Heavy lifting and strenuous activities should be avoided for six weeks after the operation.

Your doctor will provide you with additional specific instructions regarding your postoperative activities, limitations, and nutrition.

Tests will be performed regularly to see how well the remaining kidney is functioning. Every year, a urinalysis (urine test) and blood pressure check should be performed, and kidney function tests (creatinine and glomerular filtration rate) should be performed every few years (or more often if abnormal results are found). The presence of protein in the urine might indicate that the kidney is damaged.

People who only have one kidney should avoid sports that require intense contact or collision. Examples include boxing, field hockey, football, ice hockey, lacrosse, martial arts, rodeo, soccer, and wrestling. Moreover, extreme sports such as skydiving may be avoided. Anyone with a single kidney who chooses to engage in these activities should use extreme caution.

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Medically Reviewed on 4/27/2022
References
Image Source: iStock Image

Radical Nephrectomy with Transperitoneal Subcostal Incision for Large and Locally Advanced Tumors of the Right Kidney: https://ar.iiarjournals.org/content/32/11/5023

Transperitoneal Laparoscopic Radical Nephrectomy Treatment & Management: https://emedicine.medscape.com/article/445458-treatment#d9