To perform a unilateral nephrectomy, the surgeon makes a flank incision to expose the kidney. (Alternatively, he may make a thoracicoabdominal or transthoracic incision if extensive renovascular repair or radical excision of the kidney and surrounding structures is necessary, or if the patient has respiratory or cardiac dysfunction.) He then mobilizes the kidney, frees it of fat and adhesions, releases the lower pole, and locates the ureter and frees its upper third. He orders the ureter double-clamped, then cuts between the clamps and ligates both ends. Next, he frees and double-clamps the vascular pedicle. The renal artery is clamped first, followed by clamping of the renal vein. The kidney is then removed distal to the clamps. After resecting surrounding perinephric fat and the ureter, if necessary, he inserts a flank catheter and Penrose drain and sutures the wound closed.

A laparoscopic nephrectomy, typically used to harvest a donor kidney, involves using narrow surgical instruments inserted through four or five ½(1.25-cm) incisions. The surgeon will make another incision about 2½ (6.5 cm) long to remove the kidney.

Nephrectomy is classified by the extent of resection or removal involved. The five types of nephrectomy are:

Nephrectomy can cause serious complications, the most common of which are
infection, hemorrhage, atelectasis, pneumonia, deep vein thrombosis, and pulmonary embolism.

Anxiety related to possible renal dysfunction secondary to nephrectomy. Based on this nursing diagnosis, you’ll establish these patient outcomes. The patient will: