How is kidney resection organized, the process of hospitalization and operation

Resection of the kidney is an operation in which the excision of a part of the organ is performed, rather than completely removing it. This surgical intervention is considered to be organ-preserving. Currently, there are two types of resection - a classic method and laparoscopic resection of the kidney.

In the classical method, access to the kidney is achieved through a large incision in the lumbar region. Laparoscopic resection involves the use of laparoscopic techniques.

Regardless of access, the main principles of surgical intervention remain as follows:

• monitoring the vessels in the kidney;
• protects the operation of the operated kidney from ischemic damage;
• elimination of tumor growth within healthy tissue;
• hermetic closure of the urinary canals;
• good homeostasis;
• closure of kidney defects.

The general rule that kidney resection is performed in cancer is the right homeostasis, which can be temporary or definitive. For temporary homeostasis, when performing an open resection, the vessels of the kidney are clamped and the compression of the resection area is performed. When the clamp is placed on the kidney's leg, thermal ischemia manifests itself, which limits the time of blood flow in the kidney. In this regard, early monitoring of the kidney vessels is required for the purpose of their subsequent clamping.

The healing of the defects of the operation is performed in conditions of their constant contact with urine. Improper sealing of defects causes many complications, such as prolonged penetration of urine into the wound, the formation of urinary fistulas, swells that can be converted to urinary phlegmon, so it becomes urgent to use additional methods of sealing the wound in the kidney.

Examination before admission

Due to the seriousness of the kidney resection operation, a thorough examination is necessary until the patient is hospitalized. The patient is given a list of required tests, examinations and consultations, which allow to assess the general condition of the patient and his ability to postpone surgery.

Ten days before the operation, the patient should refuse to take medications that affect the blood clotting system. The rest of the medication is administered normally, provided that the doctor did not prohibit their taking.

Smoking increases the risk of inflammation of the lungs and the formation of blood clots in the deep veins of the legs, in addition, reduces the saturation of blood with oxygen, provoking a decrease in the rate of recovery processes in the body.

Hospitalization for operation

Hospitalization of the patient is performed the day before the operation. The patient once again discusses with the surgeon the upcoming actions, the expected effects and possible complications. Subsequently, the patient makes out a written consent for surgical intervention and is examined by a specialist anesthesiologist.

On the day of the operation, the patient should take a shower, then change into operating underwear and compression stockings for the legs in order to prevent thromboembolic complications.

Operation:

1. Lumbotomic surgical open access during surgery - the incision is made in the lumbar region and the patient is placed in a healthy side during the operation.
2. Open front laparotomy access during resection - with access to the kidney through the anterior wall of the peritoneum, but there is a risk of forming a commissural disease.
3. Laparoscopic access - it is performed by means of endoscopic equipment with punctures on the front of the abdominal wall.
4. Retroperitoneoscopic access during surgery - it is performed by endoscopic equipment through punctures in the lumbar region through the space behind the peritoneum.

Both the latter options are considered to be gentle methods of treatment, which make it possible to reduce the risk of complications after surgery.

Complications of operation

1. Bleeding during or after surgery.
2. Blood transfusion may be necessary in case of severe blood loss.
3. Serious bleeding may require the removal of the organ completely. The frequency of such complication is not more than 1%.
4. Inflammation of the lungs.
5. Complications after general anesthesia. To prevent this complication, it is necessary to perform respiratory gymnastics after the operation is completed.
6. Thromboembolic complications, for example, thrombosis in the deep veins of the legs. To prevent the onset of complications, the following manipulations should be performed: wearing special stockings, early motor activity after surgery.
7. Urine leakage from operating wound. Occurs rarely - less than 5% of cases and, as a rule, ends spontaneously. To prevent such complications, an internal stent is established, which is removed after two to three weeks.
8. Patients with tumor formation in a single kidney, or due to impaired renal function prior to surgery, may need dialysis.
9. Incomplete removal of the tumor - manifested in 7% of cases. After the results of the histological examination, the doctor decides on the organization of additional treatment.
10. Damage to nearby organs - observed in 1% of cases.
11. Stroke, myocardial infarction.
12. Wound infection.
13. Urinary tract infection. To prevent this complication, antibiotic therapy is performed before the operation and, if necessary, after the operation. Herniated by operative intervention.
14. Formation of a hematoma.
15. Fatalities during the operation or because of complications - occur in 1% of cases.

Discharge after

The patient is discharged on the condition that he does not have problems with the intestines and is able to move, and the pain is easily stopped by taking anesthetic medications. In the first days after surgery, a person feels tired due to surgical treatment. It may take up to eight weeks for complete recovery.

Also after the operation, the patient can feel some pain in the area of ​​the surgical suture for three months.

In the first six weeks after the operation, it is necessary to give up large loads on the body, they are resolved only three months after the operation. It is also better to refuse foreign trips and from driving motor vehicles.

Nutrition after surgery is not limited, but should avoid constipation, consume a lot of liquid - up to 2 - 3 liters per day. If a person's work is not connected with physical efforts, then it is allowed to start working after 6 weeks, otherwise - only after 3 months. After two weeks it is allowed to return to sexual life.

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