Laparoscopy, surgical; nephrectomy, including partial ureterectomy
CPT4 code
Name of the Procedure:
Laparoscopy, surgical; nephrectomy, including partial ureterectomy
Summary
This procedure involves the removal of a kidney and part of the ureter through small incisions using a laparoscope, a specialized surgical instrument with a camera.
Purpose
Medical Condition:
This procedure addresses kidney diseases such as cancer, severe kidney damage, or chronic infection.
Goals:
The main goal is to excise the diseased kidney and part of the ureter to prevent further health issues and improve the patient's quality of life.
Indications
- Kidney cancer or tumors
- Chronic kidney disease with severe damage
- Recurrent kidney infections
- Traumatic kidney injury
- Non-functional kidney due to congenital issues
Preparation
- Patients may need to fast for 8-12 hours before the procedure.
- Pre-operative blood tests and imaging studies (e.g., CT scan, MRI) to evaluate kidney function and anatomy.
- Discussing medications with a doctor, including stopping certain blood thinners.
Procedure Description
- Anesthesia: General anesthesia is administered.
- Incisions: Small incisions are made in the abdomen.
- Insertion of Laparoscope: A laparoscope is inserted through one of the incisions to provide a video feed of the internal organs.
- Removal: Surgical instruments are inserted through other incisions to remove the kidney and part of the ureter.
- Extraction: The excised organs are placed in a retrieval bag and removed from the body through one of the incisions.
- Closure: Incisions are closed with sutures or surgical glue.
Tools and Equipment:
- Laparoscope
- Surgical instruments (e.g., graspers, scissors)
- Retrieval bag
Duration
The procedure typically takes 2-4 hours.
Setting
Performed in a hospital surgical suite or specialized surgical center.
Personnel
- Lead surgeon and assisting surgeons
- Nursing staff
- Anesthesiologist
- Surgical technician
Risks and Complications
Common Risks:
- Infection at incision sites
- Bleeding
- Pain at incision sites
Rare Risks:
- Injury to adjacent organs (e.g., intestines, liver)
- Deep vein thrombosis
Management:
- Antibiotics for infection
- Pain medications
- Monitoring and treatment of potential complications
Benefits
- Removal of diseased kidney tissue
- Prevention of disease progression
- Improvement in symptoms and quality of life
Realization of Benefits:
Patients may start noticing benefits within a few weeks post-surgery as they recover.
Recovery
- Hospital stay of 2-3 days post-surgery.
- Pain management with prescribed medications.
- Avoid heavy lifting or strenuous activities for 4-6 weeks.
- Follow-up appointments for monitoring healing and kidney function.
Alternatives
- Open surgery nephrectomy
- Pros: Suitable for larger tumors or complex cases.
- Cons: Longer recovery time, more significant scarring.
- Partial nephrectomy (removing only part of the kidney)
- Pros: Preserves kidney function.
- Cons: Only feasible for certain types of kidney damage.
Patient Experience
During the Procedure:
The patient will be under general anesthesia and will not feel pain or be aware of the surgery.
After the Procedure:
- Pain and discomfort at the incision sites
- Possible need for a catheter for urine drainage initially
- Gradual return to normal activities over 4-6 weeks
- Pain management with medications and comfort measures like heat packs.
Patients should follow all post-operative instructions carefully and attend all follow-up appointments for the best recovery outcome.