Product Summary: Open Radical Nephrectomy with Nodes for large tumours

Item Number: 36529, 105

For large renal tumours where laparaoscopic procedure may be contra-indicated. Bigger invasive procedure and may incur longer hospital stay and prolonged recovery process

Why is it done?

Incidental finding of a solid renal mass larger than 8-10cm suspicious of a renal cancer.

A symptomatic non-functioning kidney with the history of inflammation and abscesses where a large inflammatory process was involved making surgery technically more difficult.

Late symptoms include:

  • Hematuria.
  • Palpable Mass.
  • Flank pain.

Possible crative process for Renal Cell Carcinoma.

Cyto-reductive process prior to or post Tyrokinase Inhibitor (TKI) treatment.

Staging with:

  • CT abdomen and chest.
  • Bonescan.
  • MRI if in Renal Failure or Contrast.
  • Allergy.

Chemo-Oncologist will also be involved in your care (not for the non-functioning kidney).

Risk for post-operative dialysis will have been discussed prior to your surgery by means a referral; to a Nephrologist.

How is it done?

  • Patients will receive a general anaesthesia, unless contra-indicated.
  • Prophylactic anti-biotics is given.
  • An indwelling catheter is placed.
  • The correct kidney is identified and marked while you are awake.
  • A large sub-costal incision is made 2cm under your ribcage stretching from your side to just across the midline of the other side of your abdomen.
  • The muscles are cut.
  • The colon is reflected to reveal the retro-peritoneal space.
  • The ureter is identified and cleared up to the hilum.
  • The arteries are identified and tied off and cut first. More than 1 can be present.
  • Then the vein/ viens are tied and cut.
  • The rest of the kidney is mobilized with its surrounding fat and removed.
  • The adrenal gland is also removed in large tumours and upper pole tumours.
  • Lymphnodes surrounding the blood supply to the kidney will be removed if the tumour is larger than 4 cm.

What next?

  • You will spend up to 5-7 nights in hospital.
  • You will have a catheter for that time.
  • A drain for 2-3 days.
  • You will a trial without the catheter on the 3rd day.
  • Renal functions will be checked daily.
  • You may enter a phase of poly-uria. High production of urine as the remaining kidney adjusts to the higher work-load.
  • You will be discharged as soon as your renal function has stabilised and you can function independently
  • Allow for 6 weeks for stabilization of symptoms.
  • Restrict fluid intake to less than 3 L per day.
  • A ward prescription will be issued on your discharge, for your own collection at any pharmacy.
  • A follow-up appointment will be scheduled for 6 weeks. Remember there is no pathology due to vaporisation.
  • Don’t hesitate to ask Jo if you have any queries.


  • Minimal to significant blood loss, which may require a blood transfusion.
  • Wound Infection.
  • Post-operative hernia formations especially associated in the elderly with atrophic abdominal muscles.
  • Prolonged hospital stay due to impaired renal function recovery.
  • Dialysis as discussed by your Nephrologist, if pre-operatively indicated.
  • Post-operative Immunotherapy as prescribed by your Oncologist.
  • NB! Each person is unique and for this reason symptoms vary!

Very Important!

The correct side for surgery should be checked:

  • CT scan present
  • Your approval
  • Prior to anaesthesia being commennced.

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Nephrectomy Radical Open