Thursday, August 13, 2015

UROLAGIC OPERATION 14 nephtrctomy



Nephrectomy
Objective
In case of tumor or other disease:
•   removal of a kidney.
Position
Lateral.
Anesthesia
General.
Procedure
   1.  For benign disease a flank incision is made (with or without rib resection).
   2.  The kidney and ureter are mobilized.
   3.  The ureter is divided and the distal end ligated.
   4.  Vascular pedicle (artery and vein) is ligated.
   5.  For malignant disease a radical nephrectomy is performed.
   6.  A transperitoneal or anterior retroperitoneal incision is used.
   7.  For large upper-pole lesions, a transthoracic approach may be employed.
   8.  On the right side, the duodenum is protected with mois­tened laparotomy pads.
   9.  The vascular pedicle is transected and lymph node bearing tissue excised.
10.  The ureter is divided, and the kidney and surrounding fat, adrenal gland, and fascia are removed en bloc.
11.  If tumor is present in the renal vein, the vena cava is mobilized and the tumor embolus removed.
12.  The distal ureter is dissected free of surrounding tissues and a small cuff of bladder is excised with the intramural portion of the ureter.
13.  The bladder incision is repaired.
14.  A suprapubic cystostomy catheter may be placed and the distal ureter and bladder cuff are delivered into the flank.
15.  The flank incision may be closed with or without drainage.
16.  For trauma and some presentations of calculus disease involving only a portion of the kidney, a partial nephrec­tomy may be performed.
Instruments
•   General set
•   Deep instrument set
•   Kidney set
•   Thoracotomy tray, vascular procedures tray, and laparotomy procedures set (available)
•   Hemoclip appliers (assorted sizes and lengths) 

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