50542 Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed

Name of the Procedure:

Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring.

Summary

This minimally invasive surgery involves using small incisions and a camera to guide the removal or destruction (ablation) of abnormal growths (lesions) in the kidney. The procedure utilizes ultrasound imaging for precise guidance and monitoring.

Purpose

This procedure is performed to treat kidney masses, which can be either benign or cancerous tumors. The primary goals are to remove or destroy the lesion to prevent it from growing, improve kidney function, and reduce the risk of cancer spread.

Indications

• Presence of kidney masses or tumors detected via imaging
• Symptoms such as flank pain, blood in urine, or unexplained weight loss
• Patients with kidney cancer that is confined to the kidney
• Individuals who are otherwise healthy enough to undergo surgery

Preparation

• Fasting for 8-12 hours before surgery
• Adjusting or stopping certain medications as advised by the doctor
• Pre-surgical tests such as blood work, urinalysis, or imaging studies (e.g., MRI, CT scan) to evaluate the kidney lesion

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incisions: Small incisions are made in the abdomen.
3. Insertion of Laparoscope: A laparoscope (a thin tube with a camera) is inserted through one of the incisions.
4. Ultrasound Guidance: Intraoperative ultrasound is used to locate the kidney lesion accurately.
5. Ablation: Specialized instruments are inserted to perform the ablation, which may involve techniques such as cryoablation (freezing) or radiofrequency ablation (heating).
6. Monitoring: Continuous monitoring via ultrasound to ensure complete ablation.
7. Closure: Incisions are closed with stitches or surgical glue.

Duration

The procedure typically lasts between 2 to 4 hours.

Setting

The procedure is usually performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon specialized in urology or minimally invasive surgery
• Anesthesiologist
• Operating room nurses and surgical technicians

Risks and Complications

• Infection at the incision sites
• Bleeding
• Injury to nearby organs or blood vessels
• Adverse reactions to anesthesia
• Possible need for additional surgery
• Rarely, incomplete ablation requiring further treatment

Benefits

• Minimally invasive with smaller incisions and faster recovery
• Precise targeting of the lesion without extensive damage to surrounding tissues
• Effective in reducing or eliminating kidney masses
• Shorter hospital stay and quicker return to normal activities

Recovery

• Monitoring in the recovery room post-surgery
• Pain medication as needed
• Instructions to avoid heavy lifting and strenuous activity for a few weeks
• Follow-up appointments to monitor healing and kidney function
• Typically, patients can resume normal activities within a few weeks

Alternatives

• Open surgery: Involves a larger incision and longer recovery time but allows direct access to the kidney.
• Partial nephrectomy: Surgical removal of part of the kidney containing the tumor.
• Active surveillance: Monitoring the lesion with regular imaging studies without immediate intervention, appropriate for small, asymptomatic lesions.
• Percutaneous ablation: Needle-based procedure done through the skin.

Patient Experience

Patients may experience some discomfort or pain post-surgery, manageable with prescribed pain medications. Initial fatigue and tenderness at the incision sites are common, but most patients experience a steady improvement. Adequate pain management and following post-operative care instructions help ensure a smooth recovery.