jaron
Uploaded by
12 SLIDES
552 VUES
150LIKES

CONTRAINDICATIONS TO LAPAROSCOPIC NEPHRECTOMY

DESCRIPTION

CONTRAINDICATIONS TO LAPAROSCOPIC NEPHRECTOMY. Dr. Anmar Nassir, FRCS(C) Fellowship in Andrology (U of Ottawa) Fellowship in EndoUrology and Laparoscopy (McMaster Univ) Chairman, Department of Surgery Umm Al-Qura Univ Consultant Urology, King Faisal Specialist Hospital, Jeddah.

1 / 12

Télécharger la présentation

CONTRAINDICATIONS TO LAPAROSCOPIC NEPHRECTOMY

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CONTRAINDICATIONS TO LAPAROSCOPIC NEPHRECTOMY

  2. Dr. Anmar Nassir, FRCS(C) Fellowship in Andrology (U of Ottawa) Fellowship in EndoUrology and Laparoscopy (McMaster Univ) Chairman, Department of Surgery Umm Al-Qura Univ Consultant Urology, King Faisal Specialist Hospital, Jeddah

  3. Before starting select your patient • Pt w severe COPD • further studies (i.e., ABG and PFT) are required. • In severe COPD, helium is an alternate. • Significant cardiac arrhythmias • evaluated • treated hypercarbia and acidosis may have bad effect on the myocardium.

  4. Absolute contraindications • Uncorrectable coagulopathy • Intestinal obstruction • Abdominal wall infection • Massive hemoperitoneum/hemoretroperitoneum • Generalized peritonitis • Retroperitoneal abscess • Suspected malignant ascites

  5. Relative contraindications(if …) • Morbid Obesity • Extensive Prior Abdominal or Pelvic Surgery • Organomegaly • Ascites: Benign Etiology • Pregnancy • Hernia • Iliac or Aortic Aneurysm

  6. Relative contraindications • BMI, according to the WHO • Overweight = • 25 to 29.9 kg/m2 • Obese = • 30 to 34.9kg/m2 • Morbid obesity= • > 35 kg/m2

  7. Relative contraindications(if …) • Morbid Obesity • Extensive Prior Abdominal • Organomegaly • Ascites: Benign Etiology • Pregnancy • Hernia • Iliac or Aortic Aneurysm

  8. From inside

  9. Indications for Simple lap nephrectomy • Renovascular hypertension, • symptomatic acquired renal cystic disease • nephrosclerosis, • Symptomatic ADPKD • reflux or obstructive nephropathy, • multicystic dysplastic kidney • chronic pain of renal origin refractory to conservative measures, • chronic pyelonephritis, Fricke et al, 1998

  10. Postoperative Management • The orogastric tube is removed at the conclusion of the procedure. • Clear fluids after flatus, then normal after bowel movement. • Foley catheter removed once the patient is ambulating. • The patient is discharged when tolerating diet. • Unrestricted activity resumed according to the patient's comfort. • If a specimen has been removed through an incision, lifting is limited to 6 weeks.

  11. Results • The postop results comparable to that of open with much less pain and shorter convalescence. • Postoperative pain requirements are 4X < traditional open incisions. • LOS decreased by 50%, • Time to full convalescence has been reported to be markedly less. • Mean operative times > 300 minutes. • With advances in techniques, experience, and equipment, operative times have decreased dramatically

More Related