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)
Any questions be sent to drmmkapur@gmail.com
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