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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

  1. Anesthesia: General anesthesia is administered.
  2. Incisions: Small incisions are made in the abdomen.
  3. Insertion of Laparoscope: A laparoscope is inserted through one of the incisions to provide a video feed of the internal organs.
  4. Removal: Surgical instruments are inserted through other incisions to remove the kidney and part of the ureter.
  5. Extraction: The excised organs are placed in a retrieval bag and removed from the body through one of the incisions.
  6. 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.

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