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What happens in theatre during a nephrectomy | CION Cancer Clinics
During a nephrectomy you are fully asleep while the surgeon reaches the kidney through the side or front of the abdomen, seals its artery and vein, frees it from the surrounding fat and lifts it out, or removes only the part holding the tumour. This page walks through each stage, the three ways in, the words on the operation note, and what the surgeon cannot promise before seeing inside. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- What actually happens in theatre during a nephrectomy?
- From the anaesthetic room to the recovery bay
- Open, keyhole and robot-assisted: what changes in the room
- Whole kidney or part of it: how theatre time differs
- Words you will see on the discharge summary
- Who is in the room, and what this page cannot tell you
- Four things families ask us before a kidney operation
- Common questions about the operation itself
The short answer
What actually happens in theatre during a nephrectomy?
A nephrectomy is an operation to remove a kidney, or the part of it that holds a tumour. You are put fully to sleep, the surgeon reaches the kidney through the side or front of the abdomen, seals its blood vessels, frees it from the tissue around it and lifts it out. You wake in a recovery bay and remember none of it.
Why the blood vessels come first
The kidney filters a large share of the blood the heart pumps, so it has a thick artery and a wide vein. Most of the surgeon's early work is finding those two vessels and closing them safely before anything else is cut. Once they are sealed, the rest is slower and far less bloody. This is why theatre time is often longer than families expect.
Who this page is for
The person having the operation, and the son or daughter who will sit outside the theatre doors. It describes a typical kidney cancer operation. Your own surgeon may do things in a different order, and that is not a sign anything is wrong.
This page cannot tell you whether you should have the operation, or which approach is right for you. That decision belongs to you and your treating team.Step by step
From the anaesthetic room to the recovery bay
-
Going to sleep
A drip goes into the back of your hand. The anaesthetist gives the medicine through it and you are asleep within a few breaths. A breathing tube is placed only once you are unconscious.
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Positioning
You are turned onto your side with the affected kidney uppermost, and the table is bent slightly to open the gap between ribs and hip. A urine catheter is placed.
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Reaching the kidney
Either one long cut below the ribs, or several small cuts for a camera and long instruments. The surgeon moves the bowel gently aside and opens the fatty envelope the kidney sits in.
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Sealing the vessels
The artery is closed first with clips or a stapler, then the vein. That order stops the kidney swelling with blood that cannot leave. This is the most careful part of the whole operation.
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Removing the kidney or the tumour
For a radical nephrectomy the whole kidney comes out inside its fat, in a bag, through the largest cut. For a partial nephrectomy only the tumour and a rim of healthy kidney are cut away, and the raw surface is stitched closed.
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Checking and closing
The surgeon looks for bleeding, sometimes leaves a soft drain tube, and closes the layers. You are woken in theatre and moved to recovery, where a nurse stays with you until you are properly awake.
Not sure whether this applies to you?
Ask an oncologistThree ways in
Open, keyhole and robot-assisted: what changes in the room
The inside of the operation is the same. What differs is how the surgeon reaches the kidney and how big the cuts are.
Open surgery
One longer cut along the side or across the upper abdomen. The surgeon sees and feels the kidney directly. Usually chosen when the tumour is large, has grown into the vein, or earlier surgery has left scarring inside.
What it means for you
- A larger scar, more pain in the first week
- Usually a longer hospital stay
Keyhole (laparoscopic)
Gas lifts the abdominal wall, and the surgeon works through small cuts while watching a screen. The kidney comes out through one cut, slightly widened. Suits most contained tumours.
What it means for you
- Smaller scars, quicker return to walking
- Shoulder-tip ache from the gas is common
Robot-assisted
Keyhole surgery where the instruments are held by robotic arms that the surgeon controls from a console in the same room. The robot does nothing on its own. Used most for partial nephrectomy, where fine stitching inside the body matters.
Not every centre has a robot. Ask your surgeon which approach they recommend for you, and why.Side by side
Whole kidney or part of it: how theatre time differs
Radical nephrectomy (whole kidney)
Partial nephrectomy (tumour only)
Artery and vein sealed for good; the kidney comes out with its fat
Artery clamped briefly, released once the tumour is out and the kidney is stitched
Chosen for larger tumours, central tumours, or vein involvement
Chosen for smaller tumours at the edge, or where the other kidney is weak
Usually shorter once the vessels are found
Usually longer, because the cut surface must be closed without leaking urine or blood
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On the operation note
Words you will see on the discharge summary
- Hilum
- Where the artery, vein and urine tube enter the kidney. "Hilar control" means the surgeon has sealed the vessels there.
- Gerota's fascia
- The fatty envelope around the kidney. In a radical nephrectomy it is removed intact with the kidney so the tumour is never opened.
- Warm ischaemia time
- In a partial nephrectomy, the minutes the artery was clamped and the kidney was without blood. Surgeons keep it short.
- Frozen section
- A quick look at tissue under the microscope while you are still asleep, to check the cut edge is clear of tumour.
- Specimen
- What was removed. It goes to the pathology lab, and the full report takes some days. Nothing on the discharge summary is that report.
Being straight with you
Who is in the room, and what this page cannot tell you
A kidney cancer operation is done by a team. The surgeon and usually an assistant operate. The anaesthetist and a technician watch your breathing, heart and blood pressure the whole time. A scrub nurse hands instruments, and a runner fetches what is needed.
What the surgeon cannot promise beforehand
A plan for keyhole surgery can change to an open cut once the surgeon sees inside. A plan to keep part of the kidney can change to removing all of it if the tumour sits deeper than the scan suggested. Your consent form will usually cover both. This is the surgeon choosing the safer path with better information than a scan could give.
What only the pathology report can say
Nothing that happens in theatre tells you the type of tumour, its grade, or whether the edges were clear. The surgeon may say the operation went well, and mean it. The report that shapes what comes next arrives later.
If the person outside the doors is you, ask roughly how long the team expect to take, and add an hour for waking and recovery before you start to worry.Commonly believed
Four things families ask us before a kidney operation
"Opening the body lets the cancer spread through the air."
Air does not carry cancer cells, and the kidney is removed inside its own envelope of fat so the tumour is not cut into. Placing it in a bag before lifting it out is done for exactly this reason.
"Keyhole surgery is a smaller operation, so it must be safer."
It is the same operation inside. The cuts are smaller and recovery is often quicker, but the vessels sealed and the kidney removed are identical. For some tumours an open cut is the safer choice.
"One kidney means a life on dialysis."
A single healthy kidney handles the work of two for most people. Your team checks how well the other kidney works before the operation, and that result shapes whether they remove all or part of it.
"If the surgeon takes longer than they said, something has gone wrong."
Theatre time includes putting you to sleep, positioning, and waking you. Finding the vessels safely takes longer in a large person or after earlier surgery. Longer usually means careful, not worse.
Questions we are asked
Common questions about the operation itself
How long will I be in the operating theatre?
It varies with the approach, the size of the tumour and how easily the surgeon can reach the vessels. A partial nephrectomy often takes longer than a whole-kidney removal because of the stitching. Ask your surgeon for their own estimate.
Will I feel anything or wake up during it?
No. You are under a general anaesthetic for the whole operation, and the anaesthetist measures the depth of sleep continuously. Waking during surgery is very rare with modern monitoring.
Where will the scar be?
For open surgery, along the side below the ribs, or across the upper abdomen. For keyhole or robot-assisted surgery, several small marks around the side and one slightly longer cut where the kidney was taken out.
Can the surgeon change the plan once they are inside?
Yes, and your consent form usually says so. A keyhole operation can become an open one, and a partial removal can become a whole one, if that is the safer route once the surgeon can see the tumour. It is a judgement made for your safety.
Will I need a blood transfusion?
Most kidney operations finish without one, but the kidney has a rich blood supply, so blood is always grouped and kept ready. If you have a religious or personal objection to transfusion, tell the surgeon and anaesthetist well before the day so a plan can be agreed with you.
What tubes will I wake up with?
Usually a drip in the arm, a urine catheter, and sometimes a soft drain from the wound. Some people also have an oxygen mask for the first hours. Each is removed on the ward as you recover, and the nurses will tell you what each is for.
Will the family be told how it went straight away?
Usually the surgeon speaks to the family soon after the operation ends, while you are still in recovery. They will say what was removed and whether it went as planned. They cannot say what the tumour is or whether the edges were clear; that comes from the pathology report.
Is the removed kidney kept or shown to us?
It goes straight to the pathology laboratory in preserving fluid, because the report depends on it. What matters is the written report, which your team will go through with you.
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Sources
- Cancer Research UK — Surgery for kidney cancer
- NHS — Kidney cancer: Treatment
- American Cancer Society — Surgery for Kidney Cancer
- National Cancer Institute — Renal Cell Cancer Treatment (PDQ) - Patient Version
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Bleeding Risk During Kidney SurgeryWhy blood is kept ready and how the team limits lossNephrectomy With Tumour Thrombus in the VeinHow the operation changes when the tumour has grown into the veinAnaesthesia for Cancer SurgeryWhat the anaesthetist does while you are asleepThe Day of the OperationWhat happens before you reach the theatre doorsDrains, Tubes, Lines and CathetersWhat each tube you wake up with is for
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