Part of the TeachMe Series

Consent: Nephrectomy

Not yet rated
based on ratings

Last updated: June 18, 2021
Revisions: 5

Last updated: June 18, 2021
Revisions: 5

format_list_bulletedContents add remove

This article is for educational purposes only. It should not be used as a template for consenting patients. The person obtaining consent should have clear knowledge of the procedure and the potential risks and complications. Always refer to your local or national guidelines, and the applicable and appropriate law in your jurisdiction governing patient consent.

Overview of Procedure

A nephrectomy is a major urological operation, commonly performed for renal cell cancer, however less common indications include a non-functioning kidney containing a staghorn calculus or persistent haemorrhage following renal trauma.

The procedure can be done either open or laparoscopically, with choice (and incision site) dependent on patient factors, disease factors, and surgeon preference.

Complications

Intraoperative

Complication Description of Complication Potential Ways to Reduce Risk
Haemorrhage Damage can occur to major abdominal vessels, including the aorta and IVC Careful and meticulous dissection and maintaining the correct planes
Damage to surrounding structures Injury to nearby structures, including spleen, liver, pancreas, bowel Careful and meticulous dissection and maintaining the correct planes
Anaesthetic Risk Includes damage to the teeth, throat and larynx, reaction to medications, nausea and vomiting, cardiovascular and respiratory complications Forms a part of the anaesthetist assessment before the operation

 

Early

Complication Description of Complication Potential Ways to Reduce Risk
Pain Regular analgesia post-operatively and the use of local anaesthesia at the incision site
Infection Surgical site infections or intra-abdominal collection can develop
Blood Clots DVTs and PEs are a possibility in any operation. The risk is increased in patients with a raised BMI, on the pill, recent flights, previous DVT, pregnancy, smokers, cancer and prolonged bed rest. The patient will be given anti-embolism stocking and low molecular weight heparin peri-operatively to minimise this risk as deemed appropriate.
Stroke, MI, Kidney Failure, Death Although small, this is always a risk in any major surgery

 

Late

Complication Description of Complication Potential Ways to Reduce Risk
Incisional Hernia  Development of a hernia through the incision sites, especially when an open approach is used
Chronic Kidney Disease Reduction in the creatinine clearance following the removal of a kidney
Disease recurrence Cases performed for cancer, there always remains a risk of recurrence
TeachMeSurgery