Laparoscopic renal tumor resection

Laparoscopic surgery became a trend in the early 1990s due to laparoscopic cholecystectomy. Its benefits are obvious, avoiding the discomfort and complications that traditional laparotomy wounds bring to patients. However, the use of laparoscopy to remove renal tumors may limit the extent of resection. The scope of radical resection of renal cancer is relatively large, and general surgery should be performed through the abdominal cavity. Although some Japanese scholars have reported the experience of successful laparoscopic surgery, it is recommended that the surgeon must have sufficient experience before implementing it. Treatment of diseases: kidney tumors Indication 1. Benign tumors of the kidney. 2. Malignant tumors with an early diameter of less than 4 cm, no local infiltration, no need for lymph node dissection. Contraindications 1. Middle and late stage renal malignancies with local infiltration or lymphatic metastasis. 2. Abdominal organs have adhesions that are not suitable for laparoscopic surgery. 3. Patients with renal vein or vena cava tumors. 4. The general condition is not allowed. Preoperative preparation Prepare routinely before surgery. Surgical procedure First, the patient was placed in a supine position, and a 1 cm incision was made beside the navel. The abdominal gas balloon was placed to perform abdominal perfusion to 2 kPa. The surgical cannula was placed at the set position and the patient was placed on the side. After the laparoscope enters the abdominal cavity, the liver, gallbladder, spleen and intestines are examined first. The lateral peritoneum of the colon was incised with an endoscopic scalpel and the colon was freed to the medial side. In order to make the renal vascular can have tension suitable for dissociation, do not cut off the junction between the lateral side of the kidney and the abdominal wall at this time, otherwise the kidney will fall to the inside and cause difficulty in renal vascular detachment. The right side of the surgery should be careful to avoid injury to the duodenum, while the left side should pay attention to the pancreas. When the renal hilum is free, the renal vein is usually separated from the front, and then the renal artery is searched for from below. When the renal artery is free from 2 to 3 cm, the blood vessel can be clamped with a large blood vessel clamp. Generally, at least 3 clips are at the proximal end and 2 clips are at the distal end. After the renal artery is severed, the renal vein is further dissociated. Because the renal vein wall is thin, especially the right renal vein is short, care should be taken to avoid severe traction and damage the junction of the inferior vena cava and the renal vein. After completely freeing the renal vein, it can be cut with an endovascular stapler (Endo GLA). If it is not easy to completely clamp the clip using only the blood vessel clip, the cut is quite dangerous. After the renal valve is treated, you should pay attention to the adrenal artery and vein. The upper pole of the kidney is then released from the liver (right) or the spleen (left). Then, the kidney is completely dissociated from top to bottom, and finally the ureter is separated. After the ureter is cut off, the whole kidney can be pulled with a tweezers, placed in a nylon bag, and then taken out. The surgical area was examined to determine that there were no other organ injuries and sutured abdominal wall cannula incision.