SAOP3- Kidney Surgery
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Which kidney is located more cranially?
Describe the vasculature of the kidneys.
renal a enters at hilus--> branches to dorsal and ventral--> interlobar a--> interlobular a--> arcuate a
What are suture considerations for the urinary system?
- avoid non-absorbable suture
- monofilament best (multifilament has irregular surface that is a nidus for bacteria)
- avoid prolonged absorbable (bladder heals QUICKLY AND WELL)
- suture size 3-0 to 5-0
What are surgical approaches to the urinary tract?
- ventral midline
What are advantages of ventral midline approach?
- provides exposure to all structures within the abdominal cavity
- upper UT within retroperitoneal space
- bladder ventral to colon within peritoneal cavity
Flank approach facilitates exposure to what structures? (4)
What do you incise for the flank approach?
- ext and int abdominal oblique
- transversus abdominis (close all 3 separate muscle layers individually)
What are potential complications of minimally invasive renal biopsy with tru-cut? (3)
- small biopsy sample inadequate
- location of sample non-diagnostic
- hemorrhage, hemostasis
When do we do a surgical biopsy instead of minimally invasive? (6)
- celiotomy needed for other reasons
- need to visualize both kidneys
- patient with a bleeding disorder, need better hemostasis
- need a larger tissue sample
- position of kidney does no lend itself to percutaneous access
- obese patient
Where is the highest concentration of nephrons, ie. is the goal for biopsy location?
- renal cortex
- corticomedullary junction
How do you position the tru-cut needle when performing a biopsy needle?
- parallel to the long axis of the kidney
- avoid hilar region
- biopsy renal cortex
What are considerations with open wedge biopsy of the kidney? (3)
- use #10 or #15 scalpel blade to incise 4-6mm pie-shaped wedge from greater curvature
- incise through cortex
- expect hemorrhage and hematuria
How do you close a renal wedge biopsy?
4-0 absorbable suture to close renal capsule in simple continuous (avoid going too far into parenchyma, suture capsule)
What are potential complications of wedge renal biopsy? (3)
- hemorrhage- hematuria, subcapsular hematoma, hemoabdomen
- laceration of renal pelvis- uroabdomen
- insufficient biopsy sample- lack of nephrons
How do you incise the kidney for nephrotomy?
- incise along greater curvature to avoid major vessels
- tourniquet hilus for 3-5 min max
How do you close a nephrotomy incision?
capsular suture with 3-0 to 4-0 chromic gut simple continuous
What are potential complications of nephrotomy? (3)
- renal parenchymal injury, renal failure (hypoxia d/t tourniquet, surgical injury)
- failure to completely remove obstruction
Why is a pyelotomy?
- surgical incision made directly into the dilated renal pelvis to remove nephroliths
- does not require tourniquet, avoids injury to renal parenchyma
- VERY difficult if the pelvis is not extremely dilated
How do you close a pyelotomy?
- 5-0 or 6-0
- absorbable (monocryl)
- simple continuous
What is the purpose of a nephrectomy?
- salvage procedure to remove a non-functional kidney (congenital dysplasia, hydronephrosis, pyelonephritis, neoplasia, trauma)
- only is contra-lateral kidney is functional
BUN/Cre are elevated with...
75%+ loss of renal function
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