Laparoscopic Treatment of Kidney and Ureteral Disease

This article describes kidney cysts and explains the laparoscopic procedures that are used to treat them. Operation microscopes may be used during the procedure. Kidney cysts are more aptly called Autosomal Dominant Polycystic Kidney Disease and are areas in the kidneys that are filled with fluid.

ADPKD often exhibits with swelling and pain the abdominal area. However, the patient may be asymptomatic with small cysts that are present in the kidney. A person with ADPKD may have high blood pressure and signs and symptoms of infection.

Genetics play a big part in this disease and is known to be inherited. A person is at a higher risk if there is a member of the family with the disease. Cysts may also form not only in the kidneys, but in the liver, pancreas and brain as well. With the time element, these cysts may enlarge, eventually leading to renal failure, resulting in dialysis or the requiring a kidney transplant. The article recommends eating a low salt diet and consuming red meats to a minimum so as not to overload the functions of the kidney. However if the cysts are already evident and are increasing, surgical intervention may ensue. There are a number of laparoscopic techniques discussed.

Laparoscopic cyst decortication is the procedure where three to five incisions are made on the abdomen of the patient. Through these, a telescope and other instruments like operation microscopes used for dissection is inserted to remove and drain the cysts that are evident outside of the kidney. This kind of operation is for those who have kidney cysts that are big, causing great discomfort for the patient with ADPKD.

Laparoscopic nephrectomy also involves performing 3 to 5 incisions on the abdomen and the insertion of a telescope for viewing the cavities and surgical dissecting instruments. However, this procedure is performed to remove the kidneys that are not functioning anymore or kidneys that have tumors. The removal is done by ligating the blood vessels and the ureter that is attached to the kidney. Still inside the abdomen, the kidney is placed in a sack before pulling it out.

Another minimally invasive method is via laparoscopic pyeloplasty. This time, 4 to 5 incisions are made on the abdomen. Again, a telescope and dissecting instruments are inserted. The surgeon then performs the restoration or repair of the ureter, where scarring or injury may have occurred. For the surgeon to have a closer magnification of the procedure, operation microscopes may be used. This procedure is performed to relieve an obstruction caused by a cyst or a tumor, disrupting the flow of urine to pass into the ureters and then to the bladder. This disorder is called ureteropelvic junction (UPJ) obstruction and patients are generally born with this disorder.

Risks for these types of surgeries, even if they are minimally invasive, still have to be explained in detail to the patient by the surgeon and the subsequent consent forms have to be signed and witnessed. These risks include bleeding, allergic reaction to the anesthetic and post operative infection and discomfort. Urine leakage may also result after the operation. As the operated area of the ureter is healing, a ureteral stent, a tube that helps the kidney drain into the bladder is inserted temporarily and is removed after 2 or 4 weeks after the operation. The patient should be informed that some discomfort and the presence of bloody urine and hematuria may be observed while the stent is in place. Read more on this topic Read more on this topic