For many years, patients with kidney tumors were treated with open surgeries such as removal of the entire kidney or only the tumorous part, removal of a non-functioning kidney, and similar surgeries. However, with the development of laparoscopic (closed) surgery techniques in the field of medicine, open surgeries began to be replaced by closed surgeries in the field of urology. Although this technique has become the standard in America and European countries today, open surgery is still performed in many centers in our country. These are based on equipment shortages as well as the small number of experienced urologists trained in this field.
What is laparoscopic kidney surgery?
Kidney surgeries are performed by making very small (about 1 cm) incisions at several points in the abdomen and using long instruments and a camera system inserted from there. The procedure of removing a non-functioning kidney is called Laparoscopic Nephrectomy, in kidneys with large tumors, the closed removal of the entire kidney is called Laparoscopic Radical Nephrectomy (Figure 1), and in kidneys with small tumors, the closed surgery in which only the tumor (very little of the healthy parts of the kidney are removed) is called Laparoscopic Partial Nephrectomy (Figure 2). . In addition, the surgery to correct renal duct stenosis is called Laparoscopic Pyeloplasty.
What are the advantages of laparoscopy?
One of its biggest advantages is that very small incisions are made instead of the incisions that were previously made around 20-30 cm and sometimes even 40 cm. This not only means a better cosmetic appearance, but also a quicker and smoother recovery. This becomes especially important in patients whose wounds close late or are prone to infection, such as diabetics. In addition, it offers the advantages of patients staying in the hospital for a shorter period of time as they recover faster, returning to their daily life activities more quickly, and being able to start work more quickly. Again, patients have the advantage of feeling less pain and using less medication after surgery. Especially in experienced hands, surgery times are shorter than open surgeries and the patient requires less anesthesia. is crying.
Are all cysts or masses in the kidney malignant (cancer)?
Some of the masses seen in the kidney may have the structure of cysts (fluid-filled bubbles), while others may It may have a texture consistency. Some of the kidney cysts, and the most common form in society, are called "simple cysts" and most of the time they do not cause any harm to the patient and do not require treatment. At the same time, it does not carry the risk of turning into cancer. However, some of the cysts we define as "complicated cysts" may already contain cancer cells or may show cancer transformation in the future.
Tissue-like masses vary widely, including benign ones, as well as many types of malignant kidney tumors. However, the biggest handicap here is that it is very difficult to decide whether these masses are good or bad, using both tomography, ultrasound and MRI scans. Clear distinction of very few kidney masses can be made with these films.
In which case surgery is required?
As we mentioned above, if there is a mass in the kidney that is thought to be a malignant tumor, it definitely needs to be operated on, because It is not possible to treat them with medication. In this case, the surgery to be performed is decided by looking at the location and size of the tumor within the kidney. If possible, an operation in which only the tumor is removed while preserving the kidney (laparoscopic partial nephrectomy) is performed. If the tumor covers most of the kidney, then the tumor must be removed together with the kidney (laparoscopic radical nephrectomy).
Apart from tumors, in cases where a kidney has decayed and is not working, surgery is decided by looking at a few criteria. If a non-functioning kidney constantly causes infection, causes pain or causes high blood pressure, then kidney removal surgery (laparoscopic nephrectomy) is appropriate. If it does not cause any of these, but there is a stone inside or it is very swollen, surgery is required again. In case of congenitally small kidneys, surgery is not required if the above conditions are not present. Kidney, which we call simple cyst In cysts, when the cyst reaches a certain size, it may need to be removed by laparoscopic method.
In renal duct stenosis, which is mostly detected in childhood, an examination called scintigraphy is performed to check whether this stenosis damages the kidney. When the decision for surgery is made based on this test, the narrow part of the renal canal is removed using the laparoscopic method, the other parts are combined and the normal functioning of the kidney is ensured.
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