Pediatric Surgery Wilms Tumor

Surgery for Wilms’ Tumor

Definition

In cases of abnormal and uncontrolled growth of kidney(s) in children, resulting in:

•   Non-functioning of the kidney

•   Spread of tumor locally as well as to lungs

•   Deterioration in general health.

Objectives

•   Removal of the entire tumor including the affected kidney

•   Staging of the tumor, lymph nodes sampling

•   Histopathological grading of tumor

•   Supplement with chemotherapy and radiotherapy, to prevent recurrence.

Position

Supine, with a towel under the loin.

Anesthesia

General with endotracheal.

Procedure

   1.  Large transverse abdominal skin incision over the tumor.

   2.  Divide the muscles.

   3.  Open the peritoneal cavity.

   4.  Reflect the colon medially.

   5.  Define and ligate the renal vessels.

   6.  Free the tumor from all sides.

   7.  Leave the adrenal gland, if not involved.

   8.  Ligate the ureter as low down as possible.

   9.  Remove the kidney with the tumor.

10.  Avoid any tumor rupture/spill.

11.  Assess the other kidney and biopsy the lymph nodes if any.

12.  Close the abdominal wound in layers.

Options

1.  Renal preserving surgery, if feasible.

2.  Minimal surgery if bilateral disease.

3.  Biopsy only, if an extensive and fixed tumor.

Instruments

General pediatric surgical set.

Sutures

•   3/0 Catgut             2

•   3/0 Silk                               4

•   2/0 Silk                               4

•           4/0 Nylon 

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