Heminephrectomy Unilateral

Heminephrectomy unilateral surgery

Unilateral heminephrectomy is an operation to remove one of the two poles (one side) of a single kidney (either upper pole or lower pole) and spares the other half of the healthy weight of kidney tissue. It is typically only done in a patient that has a duplex (duplicated) collecting system, in which one arm of the kidney is diseased or dysfunctional.

Characteristics that indicate Unilateral Heminephrectomy

This is the operation performed when only a portion of one kidney is involved as in:

• Renal moiety in duplex kidney that is not functional.
• Regular UTIs
• Blocked or reversed arm of the kidney.
• Ureterocele with duplex systems.
• Severe scarring or single pole kidney damage.
• Congenital defects (usually in children patients)

Unilateral heminephrectomy can be divided into various types

• Upper pole heminephrectomy (most common).
• Lower pole heminephrectomy

Based on approach:

• Open heminephrectomy

• Laparoscopic heminephrectomy

• Robotic-assisted heminephrectomy

The Advantages of Unilateral Heminephrectomy

• Maintains healthy kidney tissues.
• Minimizes the threat of chronic kidney disease.
• Cures frequent infections or obstruction.
• Minimally invasive alternatives are quicker to heal.
• Particularly useful in children.

Unilateral heminephrectomy procedure

Unilateral heminephrectomy is a form of kidney-sparing surgery whereby one pole (usually the upper pole) of one kidney is excised and the rest of the healthy renal tissue is preserved. It is mostly carried out in patients whose collecting system is duplex particularly in children, although it is carried out in adults when a portion of the kidney is not performing.

Preoperative Preparation

• Clinical evaluation and history.
• Radiological investigations: Ultrasound, renal scan, CT or MRI. 
• Blood and renal function tests.
• Antibiotics before surgery
• General anaesthesia physical conditioning test.

Procedure:

Anaesthesia

• This is done under general anaesthetic operation.

Position of the Patient

• Patient is placed in the side lying position. 
• Affected side kidney is raised upwards.

Surgical Approach

Based on the approach taken:

• Open technique: Flank or abdominal.
• Laparoscopic: 3-4 little key holes.
• Robotic-assisted strategy: Improved accuracy of robot arms.

Detection of Renal Anatomy 

• A CT scan can be used to detect the renal anatomy.
• The kidney is very cautiously unlocked.
• It is identified as upper or lower pole moiety.
• The supply of blood to the affected segment is follow-up traced.
• Related ureter of the diseased moiety is discovered.

Vascular Control

• Segmental renal artery and vein supplying diseased pole are isolated and put under control.
• This is important to avoid the destruction of the normal renal tissue.

Removal of Diseased Renal Pole 

• The nephrectomy for the non-functioning segment of the kidney was performed via surgery.

Care is taken to preserve:

• Blood supply
• Gathering system of the rest kidney.

Ureter Management

The ureter of the renal segment removed is:

• Excised completely, or
• Catheterized and debrided the wound to avoid infection or stump issues.

Hemostasis and Reconstruction

• Never hairy bleeding is carefully monitored.

Renal defect may be:

• Sutured, or
• Stamped with hemostatic agents.
• A drain can be laid where necessary.

Closure

• Surgical wounds are dressed in layers.
• Dressing is applied

Duration of Surgery

• Dependent on anatomy, age, and method of surgery, 2-4 hours.

Postoperative Care

• Medication control of pain.
• Early mobilization
• Keeping track of urine output and renal activity.
• Taking away drain 24-72 (when it was inserted)
• Average time to discharge is 2-5 days.

Robotic heminephrectomy unilateral

Robotic unilateral heminephrectomy is a minimally invasive kidney sparing operation where the pathological upper or lower pole of either kidney is resected with a state of the art robot-assisted surgery whilst the intact kidney tissue is preserved. It is also most usually done to duplex kidneys, particularly when one of the moieties is non-functioning.

Indications

Unilateral heminephrectomy Robotic unilateral heminephrectomy would be recommended in:

• Non-functional renal moiety duplex collection system.
• Repeat urinary tract infections.
• Refluxing or obstructed renal segment.
• Duplication kidney ureterocele.
• Localized one-pole injury to kidney.

Heminephrectomy unilateral recovery

Recovery after a unilateral heminephrectomy is usually uneventful as the individual has complete renal function since one kidney is removed. 

Recovery after Surgery (Within 24-72 Hours) 

• Observation: Kidney, urine and vital signs.
• Pain management: IV and oral pain drugs.
• Fluids: IV fluids, followed by gradual oral fluids.

Drain & catheter:

• Catheter in the urine usually to be removed in 24-48 hours.
• Surgical drain (when used) should be removed when the output becomes minimal.
• Mobilization: Advocated in the first 24 hours to avoid complications.

Hospital Stay

• Robotic/Laparoscopic: 1–3 days
• Open surgery: 3–5 days

First 2 Weeks After Discharge

• Light pain or discomfort at points of incision.
• Fatigue is common
• Light walking encouraged
• Do not lift heavy objects (>5-7 kg).
• Maintain good hydration
• Use antibiotics and painkillers that are prescribed.
• Change the dressing and care of the wound.

Week 3 -6 (Intermediate Recovery Phase)

• Progressive reorientation to normal life.

• Less pain and increased energy.

Return to work:

• Desk job: 2–3 weeks
• Physical job: 4–6 weeks
• Driving can be resumed after the pain medication is terminated.

Long-term Recovery and Follow-Up

• Renal functioning: Generally stable, normal.

Follow-up tests:

• Nuclear scan or ultrasound (as recommended).
• Blood and urine tests
• Children: Compensatory growth may be observed in the left-over kidney tissue.
• Diet: No permanent dieting unless recommended.

Unilateral heminephrectomy complications

Unilateral heminephrectomy is usually safe kidney-sparing surgery with a high success rate. Nevertheless, similar to any operation, it has its share of intraoperative, early postoperative and late complications. The majority of complications are rare particularly in cases where qualified surgeons are in charge with the laparoscopic or robotic systems.

Intraoperative Complications

• Bleeding
• Injury to remaining kidney tissue
• Vascular injury
• Injury to adjacent organs
• Challenges in anatomical dissection

Early Complications After Operation 

• Urine leak
• Infection
• Hematoma
• Pain
• Fever
• Ileus

Late Complications

• Ureteral stump syndrome
• Hypertension
• Recurrent urinary tract infections
• Loss of function in remaining renal tissue
• Scar-related issues

Best hospital heminephrectomy unilateral India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Unilateral heminephrectomy is a kidney-saving surgery that is safe and effective in cases where only one quarter of a kidney is diseased or non-functional as in duplicated kidney systems. The surgery allows preserving normal overall kidney functionality by removing diseased renal tissue and keeping normal renal tissue intact. Laparoscopic and robotic procedures have led to the unilateral heminephrectomy being linked to less pain, low blood loss, short-term hospitalization, quicker recovery and low rate of complication. Long-term results are high both in children and adults, when the surgery is conducted by qualified surgeons and the condition is managed after the operation.

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FAQ

1. Is a unilateral heminephrectomy considered a nephrectomy?

• No. Nephrectomy is removal of the entire kidney whereas heminephrectomy is resection of only the diseased portion of a single kidney.

2. Can I have a normal life after a unilateral heminephrectomy?

• Yes. The majority of patients go on to live normal lives because the remnant kidney tissue is sufficiently functioning to support the body.

3. Is the procedure safe for children?

• Yes. It is a commonly performed and well-tolerated procedure in the pediatric population, with excellent long-term results, frequently involving compensatory hypertrophy of the remnant kidney tissue.

4. Could a person’s kidney function be compromised for life?

• Generally renal function is well preserved, particularly when the remnant renal tissue is healthy.