Laparoscopic nephrectomy as the most effective kidney removal surgery
Radical nephrectomy is an operation to remove a kidney affected by an incurable pathology. If you do not make timely removal of the damaged kidney, then a person can begin unbearable pain, blood appears in the urine and develops a fever.
Laparoscopic kidney removal is an operation that is organized using a video camera and thin instruments of small size that are inserted inward through small incisions.
Removal of the kidney is performed laparoscopically to treat a variety of different surgical pathologies. Such manipulations make it possible to reduce the time required for complete recovery, as well as to improve the cosmetic result, due to the fact that the incisions are small in size in comparison with the classical open kidney removal operation.
Indications for surgery should include tumor processes in the body or disruption of the kidney. Also, a separate situation for removing a kidney in a person is a fence with the purpose of a subsequent transplant to a donor.
Features of the operation and the technique of performing
In modern medicine, the main indications for carrying out laparoscopic nephrectomy are the following pathologies: Renovascular hypertension, a chronic form of obstruction of the urinary canals accompanied by pain, chronic infections, kidney dysplasias.
The use of laparoscopic radical nephrectomy has now become standard, but more recently, physicians have been skeptical of it. The kidney is then removed intact, along with the adrenal gland in the case of a tumor in the upper pole, with lymph nodes.
Diagnosis of patients is a serious moment in the implementation of laparoscopy. The main task of the survey is a complete collection of data on the history of pathology, as well as physical examination. Much attention should be given to the study of previous surgical interventions in the organs of the peritoneum, pelvis, kidneys, the presence of additional pathologies.
In addition, it is important to pay attention to the presence in the medical history of abdominal sepsis, an inflammatory process or the implementation of radiation therapy, pathologies in the work of the heart or lungs that can place the correct preparation for surgery.
In the process of physical research, scars and hernias are noted and documented in the documents after previous operations. Absolute contraindications for laparoscopy are the generalized form of peritonitis, infection of the peritoneum wall.
The presence of scars and scars from previous surgical interventions can cause displacement of places in which trocars and other devices are installed. Surgeon. Conducting laparoscopy must remember that spikes left from past operations can be located far from skin incisions, so trocars should be placed with extreme caution for any patient with history of operations. In this situation, the patient should be warned about the risk of laparoscopy and suggest replacing it with an open surgery.
Before starting laparoscopic removal of the kidney, complete intestinal preparation is performed with magnesium citrate. The patient is instructed that it will be necessary to stop taking any antiplatelet medicines, such as aspirin, anticoagulants, non-steroidal inflammatory medications, a week before the scheduled operation. Also, laboratory tests are conducted with confirmation of adequate kidney function, the delivery of general blood tests, the blood group of a person and its Rh factor are determined.
Currently, laparoscopic nephrectomy is becoming the usual type of surgery for a variety of pathologies that previously required only an open surgical procedure.
Advantages of laparoscopic intervention in comparison with open surgery are the following: reduction in the frequency of complications during and after operation, less blood loss, less risk of infections, less aggressiveness of manipulation and traumatization of tissues. In addition, the results of such an operation are no different from an open operation.
The first laparoscopic kidney removal was organized 18 years ago, and the main indication for this operation is oncology of the kidney in the first and second stages of development without accompanying regional metastases.
There are two main accesses for performing laparoscopic nephrectomy:
- Access through the abdominal cavity.
- Access through the space behind the peritoneum, where the kidneys are located.
Each of these methods has its own merits. If in the past the patient underwent extensive surgical interventions of the organs of the peritoneal region, during which spikes were formed, which do not allow the realization of laparoscopic intervention, extra-peritoneal access remains preferable.
Contraindications to the organization of laparoscopic nephrectomy are: severe conditions of the patient, impaired coagulation properties, concomitant heart diseases, when the risk of getting complications during the operation increases.
Consequences of the
operation The flow of the rehabilitation period after the laparoscopic kidney removal operation is usually noticeably facilitated compared to open nephrectomy. This happens because of less trauma to the tissues and less volume of blood loss. Due to the fact that in the period after this operation the patient has fewer complications, the need for using anesthetics is reduced.
After the completion of laparoscopic nephrectomy, after five days of inpatient treatment of the patient, if there are no complications, they are discharged from the hospital.
There are some mandatory conditions for the life of patients with a single kidney that are required to follow after nephrectomy, namely:
- rejection of promiscuous sexual intercourse;
- prevention of hypothermia of the body;
- timely access to a doctor even with the slightest suspicion of the formation of an inflammatory process.