Nephrectomy (kidney removal): an OR 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Nephrectomy in one minute
What it is: surgery to remove a whole kidney (radical) or part of a kidney (partial), most often for kidney cancer.
Who it is for: people with a kidney tumour, a non-working painful kidney, or a kidney being donated.
Main risks: bleeding, infection, injury to nearby organs, reduced kidney function, urine leak after partial nephrectomy.
Usually: keyhole or robot-assisted under general anaesthetic, 2–4 hours, 2–5 days in hospital.
On this page: What is a nephrectomy? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in theatre? · FAQ
What is a nephrectomy?
The kidneys filter the blood and make urine. Most people manage well with one healthy kidney.
- Radical nephrectomy: the whole kidney is removed, often with the fat around it.
- Partial nephrectomy: only the tumour and a rim of healthy tissue are removed, keeping the rest of the kidney.
Most are done by keyhole or robot-assisted surgery; large tumours may need open surgery. The surgeon controls the artery and vein to the kidney before removing it, or clamps them briefly during a partial nephrectomy.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- kidney cancer
- a kidney that no longer works and causes pain or infection
- living kidney donation
The decision is made with your urology and cancer team, who will talk through the reasons, the alternatives (including partial removal, ablation or surveillance) and the risks with you.
When is it done?
Most operations are planned; some are urgent. Before it, you usually have:
- a CT scan and sometimes other scans
- blood tests, including kidney function, and an ECG
- a review of medicines, especially blood thinners, as per centre protocol
- a chance to ask questions and give consent
Step by step
1. Getting ready
Team brief and WHO checklist first, including the side and site marking. The anaesthetic team and ODP give a general anaesthetic (with the patient on their side, as per centre protocol) and place lines as needed; antibiotics and blood-clot prevention are given as per centre protocol. The circulating practitioner checks positioning, pressure areas, the diathermy plate, warming, and that the camera stack (and robot, if used) works. The scrub practitioner sets up the keyhole trolley and an open set in case of conversion, and does the first count. The patient is positioned on their side with the side marking checked and supports secured; an open set and vascular clamps are ready.
2. Access
Usually three to five small port cuts on the side of the abdomen; larger tumours may need an open cut under the ribs or in the flank.
3. Removing the kidney
- A. Tumour found. The kidney and tumour are identified.
- B. Vessels controlled. The artery and vein are clipped or stapled, or clamped for a partial.
- C. Kidney freed. The kidney (or tumour) is freed and placed in a bag.
- D. Removed. The specimen is removed through an enlarged cut.
For a partial nephrectomy, the clamp time is called out and the kidney is repaired with sutures.
4. Finishing
Bleeding is checked, a drain may be placed, per surgeon, and the cuts closed. Final counts are confirmed, the specimen labelled with side and checked, and the patient goes to recovery with a full handover.
Recovery and aftercare
- First days: pain relief, early walking and eating.
- Going home: often 2–5 days.
- Activity: avoid heavy lifting for about 6 weeks.
- Kidney function: checked with blood tests.
- Results: the lab report is discussed at clinic.
- Follow-up: scans as advised.
Call 999 if you have chest pain, sudden breathlessness or collapse. Contact your team urgently if you cannot pass urine, pass large clots, have a high temperature or shivering, or have severe pain.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- bleeding, sometimes needing transfusion
- infection
- injury to the bowel, spleen, liver or blood vessels (rare)
- reduced kidney function
- urine leak after partial nephrectomy
- conversion to open surgery
- blood clots in the legs or lungs
- hernia
Theatre kit list (printable)
Example kit list
Every theatre has its own protocol, and sizes and doses vary.
- laparoscopic stack: camera, scope, light source, gas insufflator and warmer
- ports, sizes per device and operator, and an entry needle or open-entry kit, per surgeon
- laparoscopic graspers, scissors, dissectors and suction-irrigation
- energy device, per surgeon
- vascular clips or stapler, per device and operator
- retrieval bag
- open set and vascular clamps on standby
- side positioning supports and pressure care
- drain and closure sutures, per surgeon
Procedural steps
- Team brief, WHO sign in; side marked; anaesthesia; lines
- Side positioning; supports; prep and drape; count
- Ports; colon moved aside
- Vessels clipped or stapled (or clamped for partial; time called)
- Kidney or tumour freed and bagged
- Specimen out; closure; counts; specimen side checked; sign out and handover
First time in theatre?
đź’ˇ First-time tip
- Know your role. Scrub, circulating, anaesthetic and ODP each have their own checks; ask at the team brief.
- Counts matter. Swabs, needles and instruments are counted before, during and at closure; speak up if one is missing.
- Specimens. Label every specimen with site and side, and check it with the scrub practitioner before it leaves theatre.
- Side check. Confirm side at every check and on the specimen label.
- Bleeding plan. Know where the open set and vascular clamps are in case of sudden bleeding.
FAQ
Can I live with one kidney?
Yes; most people live normally with one healthy kidney.
Will it be keyhole?
Most are; large tumours may need open surgery.
Will I need dialysis?
Rarely; your team checks your kidney function before and after.
Related guides
Sources
All checked on 14 October 2026. Each page's own date is shown where it gives one.
- NHS. Kidney cancer. nhs.uk/conditions/kidney-cancer
- NHS. Treatment and support for kidney cancer. nhs.uk/conditions/kidney-cancer/treatment
- StatPearls (NCBI Bookshelf), search: nephrectomy. ncbi.nlm.nih.gov/books
- British Association of Urological Surgeons. Patient information leaflets. baus.org.uk
- World Health Organization. Surgical Safety Checklist. who.int
Disclaimer
Education only. This page is for general education for healthcare students, theatre staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, surgical team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a medical emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
