D Laparoscopic nephrectomy

Indications for nephrectomy include calculus, hemorrhage, hydronephrosis, hypertension, neoplasms, transplantation, trauma, chronic infection, and vascular disease. Partial nephrectomy is performed to preserve as much renal function as possible. Surgery of the kidney is usually accomplished through a flank incision.

2. Preoperative assessment and patient preparation

a) History and physical examination: Individualized for the patient’s condition

b) Diagnostic tests

(1) IV pyelography with nephrotomography: Identify a renal mass.

(2) Ultrasonography: This differentiates simple cysts from solid tumors.

(3) Arteriography: This determines whether the kidney is suitable for renal transplantation.

(4) Computed tomography

(5) Laboratory tests

(a) Prothrombin time, partial thromboplastin time, complete blood count, electrolytes, and glucose

(b) Glomerular filtration rate: Blood urea nitrogen, plasma creatinine, and creatinine clearance

(c) Renal tubular function: Urine concentration ability, sodium secretion, proteinuria, hematuria urine sediment, and urine volume

c) Preoperative medications and IV therapy

(1) Identify the date of last hemodialysis.

(2) Epidural catheter: Perform a test dose in the preoperative area.

(3) Administer antibiotics.

(4) Use small incremental doses of benzodiazepines to facilitate anxiolysis.

(5) Have a minimum of two peripheral IV tubes (16 to 18 gauge) with moderate fluid replacement.

(6) In patients with renal failure, administer hypotonic solutions: 5% dextrose in water or 5% dextrose and 0.45% saline.

(a) Avoid normal saline: It may increase sodium levels.

(b) Avoid plasmalyte or lactated Ringer’s solution: It may increase potassium levels.

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