ISSN 2398-2950      

Kidney: surgical approach

ffelis
Contributor(s):

Rosa Ragni


Introduction

  • There are four standard methods of access to the kidneys:
    • Percutaneous blind transabdominal approach - suitable for needle biopsy with ultrasound control.
    • Laparoscopic - suitable for biopsy under direct visual control (useful in a limited number of cases).
    • Surgical - retroperitoneal (flank) approach via incision caudal to the last rib.
    • Surgical - ventral midline laparotomy (for most major renal surgery).

Uses

Biopsy

  • Investigation of:
    • Hematuria Hematuria.
    • Proteinuria Proteinuria.
    • Abnormal renal size/shape.
    • Renal insufficiency Kidney: chronic kidney disease if the underlying cause cannot be determined otherwise.
    • Evaluation of renal disease, eg severity, reversibility, progression.
    • Evaluation of response to therapy.

Renal surgery

Advantages

Midline

  • Good access to either kidney.
  • Visualization of focal lesions to assist sampling representative area.
  • Access to vascular supply.
  • Can mobilize and stabilize whole kidney.

Flank

  • Superior visualization of, and access to the ipsilateral kidney, especially on left side.
  • Visualization of focal lesions to assist sampling representative area.

Laparoscopic

  • Enhanced visualization.
  • Visualization of focal lesions to assist sampling representative area.
  • Allows assessment and control of hemorrhage.

Percutaneous

  • May be possible to perform without general anesthesia.
  • Less invasive.

Disadvantages

Flank

  • Difficult to expose entire kidney on right side.
  • Difficult to fix kidney.
  • Unfamiliar approach to many surgeons.
  • Challenging in very obese animals.
  • Requires full theatre facilities and general anesthesia.

Midline

  • Requires full theatre facilities and general anesthesia.

Laparoscopic

  • Limited usefulness in small size patients.
  • Requires full theatre facilities and general anesthesia.
  • Requires specialized equipment.
  • Steep learning curve.

Percutaneous

  • Must be able to identify and fix kidney before biopsy.
  • Cannot sample focal lesions without ultrasound guidance.
  • Less able to control and reassess situation (ie hemorrhage more likely).

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Bednarski R, Grimm K, Harvey R et al (2011) AAHA Anesthesia Guidelines for Dogs and Cats. JAAHA 47 (6), 377-385 PubMed.
  • Looney A L, Bohling M W, Bushby P A et al (2008) The Association of Shelter Veterinarians Veterinary Medical Care Guidelines for Spay-Neuter Programs. JAVMA 233 (1), 74-86 PubMed.

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