Consent: Nephrectomy - Podcast Version TeachMeSurgery 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x 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 Frequent questions What is a nephrectomy? A nephrectomy is a significant surgical procedure primarily performed to remove a kidney, often due to renal cell cancer. It can also be indicated for other conditions like a non-functioning kidney with a staghorn calculus or persistent bleeding from renal trauma. What are the common complications associated with nephrectomy? Common complications of nephrectomy include haemorrhage, damage to surrounding structures, anaesthetic risks, infection, and blood clots. These risks can be mitigated through careful surgical techniques and appropriate peri-operative care. How is a nephrectomy performed? A nephrectomy can be conducted via an open approach or laparoscopically, with the choice depending on patient and disease factors as well as the surgeon's preference. The incision site and method are tailored to optimise patient outcomes. What measures can reduce the risk of post-operative complications after nephrectomy? To minimise post-operative complications, regular analgesia can help manage pain, while the use of local anaesthesia at the incision site can reduce discomfort. Additionally, patients may receive anti-embolism stockings and low molecular weight heparin to lower the risk of blood clots. What are the potential late complications following nephrectomy? Late complications of nephrectomy may include incisional hernias, chronic kidney disease, and the possibility of disease recurrence in cases performed for cancer. Ongoing monitoring and follow-up care are essential to address these risks. Rate This Article