Kidney laparoscopy is a very popular method in the treatment of most organ pathologies. In approximately half of the cases or even more, doctors resort to this surgical intervention. The technology is characterized by high efficiency and safety, as well as low trauma. Laparoscopic methods are in demand when there are stones in the body, for example, in the gall bladder or abdominal cavity. In this article, we will consider the features of laparoscopic operations for kidney diseases, and methods of restoring the body after them.
Description of the method - renal laparoscopy
Kidney laparoscopy is considered not only one of the most gentle methods for diagnosing an organ, but also one of the most effective in removing cysts. Kidney
laparoscopy is considered not only one of the most gentle methods for diagnosing an organ, but also one of the most effective in removing cysts, tumors, and fight against other pathologies. All actions during the operation are carried out according to a specific algorithm, which looks like this:
- The patient is placed under general anesthesia;
- Then the necessary areas of skin are incised;
- Using special instruments, a tube is inserted;
- In order to increase visibility, carbon dioxide is pumped into the area of the operated organ.
- A miniature video camera is directed through one of the holes, helping to accurately project the image onto the monitor.
- By controlling instruments inserted through other incisions, the surgeon completes the task.
- By controlling and manipulating the movements of instruments, the doctor performs surgical tasks;
- After this, all instruments and drugs are removed and sutures are applied.
Kidney removal surgery: indications, types of intervention, rehabilitation
Surgery to remove the kidneys, or nephrectomy, is sometimes the last chance to save a person’s life. Despite the seriousness of any surgical intervention, you still shouldn’t panic when prescribing it.
When one of the paired organs is removed, the rehabilitation period usually passes without complications.
To avoid unnecessary worries, it is necessary to obtain in advance full information about the essence of the operation, the features of recovery, and the rules that must be followed to avoid relapses.
Indications for kidney removal
A threat to human life is the main reason for surgery. Radical nephrectomy is prescribed when conservative methods are powerless, and the patient’s condition worsens hourly. Surgery is indicated if the following pathologies are identified:
- Oncology - detection of malignant neoplasms in one of the kidneys, the size of which is more than 7 cm. In the case of stage III and IV cancer, only one method of treating a kidney tumor will save it - its removal.
- A benign tumor (for example, a lipoma), which has greatly increased in size, also requires immediate removal of this kidney. A sufficient reason for surgery is compression of the kidney tissue.
- Urolithiasis, which threatens extensive parenchymal damage and sepsis.
- Hydronephrosis, which provoked atrophy of the kidney tissue.
- Polycystic disease leading to kidney failure.
- Kidney injury. Due to the wound, she cannot ensure full functioning.
- Congenital defects of kidney development.
The most dangerous cause on the list is a malignant tumor. If it is detected, you cannot hesitate, since metastases tend to quickly spread to healthy organs.
Preparing for the intervention
All abdominal operations require a serious preparatory period. 20 days before the appointed date, the person is admitted to the hospital. For a comprehensive assessment of the condition and the correct choice of anesthesia, the following is carried out:
- blood tests (biochemical, general), urine tests (clinical);
- CT;
- Ultrasound of the abdominal cavity;
- urography;
- fluorography;
- ECG.
A conversation with the anesthesiologist the day before is necessary to eliminate the risk of intolerance to anesthesia drugs. It is especially important if kidney removal is scheduled in old age. On the eve of the operation - 12 hours before - the patient is given an enema. After the enema, eating is prohibited, and drinking is also not recommended. Hair removal in the kidney area is a mandatory procedure.
In the morning before surgery, an antibiotic injection is given intravenously or intramuscularly.
Open nephrectomy
The advantage of traditional cavity removal is its relative ease. Disadvantages: large incision, risk of bleeding or infection of the wound.
The operation begins with fixation of the patient. It is placed on its side: right, if a nephrectomy is being performed on the left, or left, when the right kidney is to be removed.
After injection of the anesthetic, an incision is made either under the ribs in front or on the side at the level of 10-11 ribs. The second method is preferable because it is less traumatic. However, it is not used when removing an organ in children, obese people and those who have chronic pathologies of the upper respiratory tract.
By introducing the dilator, access to other organs (pancreas and duodenum) is blocked. Clamps are placed on the ureter and large vessels. The ureter is cut, then sutured, the arteries and veins are sealed. The kidney leg is bandaged before removal, and then the diseased organ is removed.
Laparoscopy
This method is preferable, since laparoscopic nephrectomy is characterized by low trauma and an almost complete absence of complications. There is only one drawback - the complex technique of the removal operation, but this is outweighed by the advantages of the minimally invasive technique.
After the onset of anesthesia, a special tube is inserted into the subumbilical area - a trocar, equipped with a stylet and a video camera. To remove the affected kidney, the patient is fixed on his side.
They provide access to the organ using several trocars of various sizes.
The cut ureter, as well as the vessels, are clamped with staples. It is sutured only after the kidney has been removed.
Turning the patient onto his back again, the kidney is removed with the largest instrument (11 mm) - a trocar with a laparoscope.
How long does kidney removal surgery take?
To the question of how long kidney removal operations take, no one can give an exact answer. The duration of a nephrectomy depends on how it proceeds - with or without complications, and what removal technique is used.
Concomitant pathologies can also greatly affect the duration. Any unforeseen situations can significantly increase the removal time.
Average duration of operations:
- laparoscopy - 1.5 hours;
- abdominal intervention - 3 hours.
Possible consequences
The risk of potential complications after removal of a diseased kidney always exists, but it is small - only 3-10%. Much, if not everything, depends on the qualifications of the surgeon, his experience, and assistants. Consequences are rare, but they can occur both after abdominal surgery and after laparoscopic intervention.
Open nephrectomy can provoke:
- respiratory failure;
- bleeding, sepsis;
- cerebrovascular accident;
- intestinal obstruction;
- heart failure;
- injury to the pancreas, spleen;
- thrombus formation.
When one kidney is removed using a laparoscope, the following consequences are possible:
- hernias that form at the trocar entry site;
- blockage of arteries in the lungs;
- pneumonia;
- damage to nerve endings.
Removing a diseased kidney affected by cancer provokes its relapse. This consequence is being combated with new targeted drugs that target certain proteins of the cancer cell.
Rehabilitation after kidney removal
Full recovery after kidney removal is a long process, it takes from a year to two. Older people need even more time. It is quite difficult for an organ left without a pair to get used to working with double power.
Lifestyle
A kidney left alone requires increased attention. We need to work to prevent any of her illnesses. A person should be regularly examined and immediately consult a doctor at the slightest suspicious symptoms indicating an inflammatory process.
Life expectancy, forecasts and statistics
Kidney nephrectomy is not a reason to give up your life. A complete cure in combination with diet and the right regimen will not affect the quality of life in any way. There are cases when surgery to remove one kidney, performed in childhood, allows you to live into old age.
An organ removed due to cancer requires more attention. There is a risk of kidney failure. This happens 10 years after the operation, so such people need regular examinations and timely therapy if pathological changes are detected.
The number of deaths in cancer patients after surgery reaches 3%. A removed carcinoma after 5 years increases the sad statistics to 70%.
Approximate prices in Moscow
The price range is very wide; they depend both on the clinic and on the specifics of the operation. The cost of radical open removal of a kidney with a tumor in the capital ranges from 26,400 rubles to 120,000. Laparoscopic nephrectomy of various categories of complexity will cost patients 120,000-360,000 rubles.
Source: https://simptom.info/nefrologiya/operaciya-po-udaleniyu-pochek
Main reasons for lapparoscopy
This method is in high demand in various therapies for kidney pathologies.
This method is in high demand in various therapies for kidney pathologies. So, it can be prescribed in the following situations:
- When there is a need to diagnose organs in order to detect the presence of pathologies, diseases, malignant and other formations;
- If there is a need to remove a kidney organ;
- If it is necessary to perform surgery to remove various formations: cysts, stones and tumors.
Attention! As you can see, laparoscopy helps to get rid of unpleasant painful pathologies.
Advantages and disadvantages of this direction
Laparoscopy, in the absence of contraindications, is the best alternative to open surgery. This method of removing stones has a number of advantages, such as:
- minimal blood loss and tissue damage;
- short and easy rehabilitation period;
- no noticeable scars;
- low risk of infection, adhesions and postoperative hernias;
- the possibility of simultaneous removal of stones and elimination of organ anomalies.
The disadvantages of laparoscopy are the high cost and increased requirements for the surgeon’s qualifications. There are also a number of contraindications, for example:
- allergy to anesthesia;
- purulent peritonitis;
- blood clotting disorder;
- colds in the acute phase;
- exacerbation of gastrointestinal diseases;
- pathologies of the respiratory system, heart and blood vessels.
Despite the fact that the method is considered the least traumatic, complications are possible.
If the operation is prolonged, prolonged exposure to carbon dioxide may result in peritoneal injury. However, the risk of such complications is minimal.
Contraindications to laparoscopy
Despite its high effectiveness, laparoscopy is not performed in some situations
. Despite its high effectiveness, laparoscopy is not performed in some situations in which it can cause harm. It is for this reason that before prescribing it, the doctor must diagnose the patient’s condition. If he has some pathologies, especially of an infectious nature, then surgery is out of the question.
Apaan Mudra for the treatment of diseases and restoration of the kidneys
Also prohibiting the appointment of laparoscopy are problems with the functioning of the blood, including the characteristics of its clotting. If its indicators are poor, then the doctor cannot perform the operation, since there is a threat to the patient’s life. It is worth noting that there may be other contraindications, so the operation is prescribed on an individual basis, taking into account the results of the examination.
Preliminary examination before resection
It is necessary to take general blood and urine tests (average portion) to draw up a complete clinical picture of the patient’s condition. Separately, blood is drawn for tests for the presence of HIV, hepatitis and syphilis infections.
List of specific tests:
- Ultrasound;
- MRI;
- CT scan;
- excretory urography (x-ray of the kidneys with the introduction of a contrast agent);
- chest x-ray;
- angiography;
- perfusion.
Types of laparoscopic operations
Today, modern medicine has a wide range of types of operations using the laparoscopy method.
Today, modern medicine has a wide range of types of operations using the laparoscopy method. In most cases, the procedure is performed through the retroperitoneum. But the decision about the area through which the intervention will be carried out still depends on the attending physician. In addition to the place, laparoscopic operations differ according to the purposes of their implementation, among them the following stand out:
- Diagnostics. It is used to examine the kidneys and identify any pathologies;
- Elimination of stones in the kidney organs;
- To perform treatment for diseases such as a cyst or tumor;
- To carry out manipulative actions on resection functions of the kidneys;
- To eliminate various formations and pathologies.
Features of preparation for surgery
First, a conversation is held between the doctor and the patient in order to learn about pathologies and allergic reactions.
First, a conversation is held between the doctor and the patient in order to learn about pathologies and allergic reactions. Next, the doctor must explain the features of laparoscopic surgery. The patient should also be made aware of the possible consequences and complications. At this stage, the main task of the surgeon is not only to present important information, but also to set the person up for a good result. In some situations, the patient needs to lose excess body weight, so a special diet and physical activity are prescribed. In addition, the complex of the preoperative stage may include the following tasks and activities:
- A special diet can be prepared, including the necessary products to normalize the functioning of the intestines and stomach;
- A few days before laparoscopy, a procedure to cleanse the stomach and body may be prescribed;
- The day before surgery, excess body hair that may interfere with laparoscopy is removed;
- On the morning of the operation, an enema is given and hygiene procedures are carried out;
- It is not recommended to eat in the evening before surgery, and in the morning it is necessary to reduce the amount of fluid.
Postoperative period
On the first day after surgery, patients may experience pain, which can be relieved with analgesics. By the evening, most of the operated patients can get up and eat on their own.
In the postoperative period, frequent urination and nausea may occur, which usually disappear after a week.
Compliance with the regimen after the procedure
Diet after laparoscopy is very important. This will not only allow you to recover faster after surgery, but will also reduce the risk of complications. The following recommendations should be followed:
It is advisable to limit your food intake; you can drink still water in small sips.
The first day after surgery.- 2–3rd day. Liquid foods are introduced into the diet, such as jelly, pureed lean soups, and liquid porridge with water.
- 4-5 days. Mashed steamed and boiled dishes are allowed, the diet is divided into 5-6 meals per day.
- 6th day. As a rule, the patient is discharged from the hospital on this day. You should stick to a diet at home, but you can already switch to 4 meals a day.
Taking tests before surgery
Before getting on the operating table, the patient must undergo a certain examination.
Before getting on the operating table, the patient must undergo a certain examination. This is done for the purpose of diagnosing health conditions and predicting possible consequences. This complex includes the following tests:
How to find a kidney recipient and who can become a donor?
- It is necessary to give a blood sample, which should be examined for clotting index, glucose and cholesterol levels;
- Blood is also diagnosed for the presence of infectious and sexually transmitted diseases, including AIDS;
- Afterwards, the patient must undergo fluorography and an electrocardiogram.
Attention! It is very important that the patient does not have a cold and does not have any of the symptoms, such as cough, runny nose, fever.
In the presence of chronic diseases, laparoscopy can be performed exclusively during the period of remission. For this reason, it is very important to consult with your doctor. If the doctor suspects the presence of varicose veins, then a vascular scan is performed, since this disease can negatively affect the result of the operation. It is worth considering that it is possible to perform kidney laparoscopy after suffering from intestinal ailments and viruses only after two weeks.
Differences between the surgical process and radical removal
Laparoscopic partial nephrectomy also takes place under general anesthesia. The typical operation time is 2–2.5 hours and is performed through 4 small (1 cm) incisions made in the abdomen. The technology is the same as for radical excision - optics and instruments are placed into the abdominal cavity through holes, then the surgeon removes the tumor without the need to place hands in the cavity. The excision site in the kidney is sewn together with sutures and covered with a special sealant. The tumor is then placed in a plastic bag and removed by widening one of the existing incisions.
Accordingly, the rates of complications and risks correlate with those of both complete kidney removal and open surgical interventions. Possible risks with partial minimally invasive nephrectomy: bleeding, infection, traumatic condition, hernia, difficulties in the surgical process, urine leakage. Reklama: kriolipolizė, biorevitalizacija, lpg masažas, apgamų, karpų, papilomų, randų šalinimas, penio didinimas ir nepageidaujamų plaukų depiliacija lazeriu
Blood loss during this procedure is also insignificant; according to statistics, less than 5% of patients undergo transfusion. 5 weeks before surgery, blood can be collected for autologous blood transfusion.
Increased temperature, fever, drainage from the incisions, discomfort or pain when urinating are possible consequences of infection after surgery.
Increased body temperature
Injury to the intestines, liver, vascular structures, spleen, pancreas, gallbladder can occur when nerve or muscle tissue is damaged during positioning of the organ. It is also possible for scar formations to appear in the kidneys; the process is an indication for the necessary further surgical care.
Difficulties may also arise with partial laparoscopic nephrectomy, in which case it is recommended to convert the minimally invasive surgical procedure to a standard open procedure. In this case, the recovery period increases due to the larger open incision.
If the urethral collection system must be cut to remove a kidney tumor, it is usually closed with a suture. In this case, it is possible that urine leaks from this hole, then an internal drainage tube (stent) is used, which can hide the leak. In rare cases, additional surgery is required.
Recovery after laparoscopic surgery
As we said earlier, laparoscopic surgery is one of the most gentle methods of intervention. In most cases, the person is already out of bed on the day of the procedure. As for nutrition, it is also restored quite quickly. The next day, the patient can already eat liquid food. The total duration of the recovery period takes from 7 to 14 days. After this period, the individual can return to his usual routine and can even begin to perform his work duties.
Attention! Approximately several times a year, the patient should undergo an ultrasound examination to monitor the functioning of the kidneys.
Some complications may arise in situations where surgery was performed by incompetent persons. It is for this reason that it is better to contact trusted doctors and clinics. In such situations, you cannot save on health, so choose based on recommendations, not the cost of services. So we looked at all the features of surgical intervention using the laparoscopic method.
Potential Risks and Complications
If the laparoscopic method of kidney removal was carried out in accordance with all the rules, then the patient may experience several temporary complications. As a rule, they manifest themselves in the form of mild pain in the incision area. In addition, in some cases, a feeling of nausea occurs - this is a consequence of using a number of medications that are given to the patient immediately before the operation.
But situations may also arise when more serious complications develop:
- Blood loss. Laparoscopic nephrectomy is a low-traumatic operation and since it involves only a small incision, blood loss does not exceed 100 milliliters. But in 2% of cases, blood loss may be incompatible with life. It is because of this that before surgery the patient is sent to donate blood to determine the level of its coagulation.
- There is a possibility of infection entering the abdominal area. To prevent this situation, before and after surgery, doctors prescribe broad-spectrum antimicrobial drugs.
- There is a possibility of a hernia. But this kind of complication occurs in very rare cases, since during the operation a rather small hole is made, which reduces the likelihood of a hernia forming in the postoperative period.
