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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