Due to many advantages such as high safety, less pain, less post-surgery accidents, laparoscopic surgery for kidney stones is a common method today.
1. Methods of surgery for kidney stones
Kidney stones are one of the most common urinary tract diseases, the disease usually appears in males more than females, concentrated at the age of 30-55 years. Favorable factors that cause disease are due to an uns reasonable diet, too much protein, carbohydrates, sodium, oxalates, patients with urinary infections, living in the tropics,… As the urolithiasis grows gradually will interfere with the circulation of urine, which if not treated in time will lead to stagnation, obstruction, urinary infections, gradual destruction of the kidney structure.
For the treatment of kidney stones, in the past, the doctor often carried out surgery to open the abdomen to get stones. Today, less invasive methods such as extra-body gravel canopy, skin-through gravel canopy, upstream endoscopic gravel canopy, endoscopic stones taken through laparoscopy or post-itoneal,… have been carried out instead, in order to relieve pain, reduce post-surgery accidents for patients.
Laparoscopic surgery for kidney stones is a common method, the doctor will open the kidney tank to remove endoscopic stones through the mesitoneea, stones will be removed through the trocar hole.
2. In what cases is laparoscopic surgery for kidney stones in order?
Laparoscopic surgery for kidney stones is in order to remove the kidney stones in which the stones are larger than 2cm in diameter located in the renal tank of the intermediate or outer sinuses position. In addition, laparoscopic surgery for kidney stones can be combined with renal tank reconstruction surgery and ureteral stenosis in cases: patients with renal tank stones are accompanied by narrowing syndrome connecting the renal tank – ureteral kidney or ureter located behind the lower aortic vein.
Laparoscopic surgery for kidney stones is not performed when:
- Patients with contraincularity with inttocular anesthesia such as coronary artery disease, heart failure, and chronic heart failure,…
- Stones are located in the renal tank located in the sinuses, kidney tank stones are accompanied by other urinary malformation such as ureteral bladder reflux or ureteral enlargement.
- Kidney stones cause the kidneys to lose function.
- Patients with stenosis of the urinary tract under stones due to ureteral tumors, ureteral stenosis, post-peritoneal fibrosis, urinary tuberculosis.
- The patient has a history of old surgery through theitoneeal wall of the side abdomen. The person is infected with local infection of the abdominal wall, urinary infections are not treated.
3. Steps for laparoscopic laparoscopic surgery for kidney stones
3.1. Before the surgery
Patients will be given general tests and tests to assess renal function, perform ultrasounds, computerized scans of the urinary system, intravenous urological imaging to determine the characteristics of kidney stones, pathology causes or evaluation of bi-kidney function. If necessary, a radio issic issic scan will be carried out to assess the extent to which renal function is reduced or lost.
The medical staff will explain to the patient and the family the purpose of the operation, the possible complications after surgery. Medical records must have surgical consents from patients and their families. For patients with old weakness, depletion, anemia needs to improve their physical condition, stable treatment before surgery.
3.2. Steps to conduct laparoscopic surgery for kidney stones
After the patient is given in-administration anesthesia, the urethral catheter is placed. The surgeon conducts a 1cm skin incision in the navel horizontal position on the lateral white line, small opening of the peritonee, 10mm trocar placed through the first opening, inflatable 12 mmHg, placing the camera with a 30-degree lens. The other two trocars consist of 1 5mm trocar placed in the middle of the pelvic crest and the flank on the middle armpit, 1 10mm trocar placed under the flank on the white line. Once laid, 3 trocars will form an isosed triangle.
After placing the trocar, the surgical team will proceed to reveal the renal tank and remove stones:
- The surgeon opens theitoneum along toldt's conjunctivitis, lowers the right corner of the colon, pushes the colon and duodenum into the middle, extends the liver upwards (or it is possible to cut the spleen ligaments – the colon), pushes the left spleen and colon in. The doctor uses endoscopic hooks and endoscopic clips to remove the renal tank ureter from the genital vessels to the pole under the kidneys and the renal navel to reveal the front and lower shore of the renal tank. Separate the renal tank from sticking to the blood vessels of the kidney stalk.
- Reveal a kidney tank with stones, use a clamp to keep stones in the kidney tank, open the kidney tank with a cold knife or endoscopic hook for stones. After that, the suction pump washes the kidney tank and takes small pieces of gravel.
The doctor examines the circulation of the ureter down the bladder and stitches the restoration of the renal tank. After taking kidney stones, if the patient has accompanying conditions such as the ureter behind the lower aortic vein or the narrowing of the renal tank-ureter extension, the doctor can continue to perform surgery to re-shape the renal tank and narrow ureter.
Before the end of the operation, the doctor will conduct an examination of the operating area in theitonea. Abdominal pressure will be reduced below 5mmHg to check for bleeding, perform fluid draining, remove kidney stones directly through the enlarged 10mm trocar hole or put in a plastic bag. Drain the trocar and drain the operating area with a cathe tube. After that, the patient is sewn the opening of the abdominal wall with a target, put gauze, bandages and reset the position.
3.3. Patient Monitoring
During the operation, the patient will be closely monitored for vessels, arterial blood pressure, central vein pressure, blood loss, blood volume to transmit O2 and CO2 levels.
After the operation, monitor the post-operation bleeding through the number, urine color of the urethral catheter and drainage of the operating area, hemolysis, abdominal pain and obstruction. Usually, the patient's bleeding will decrease after a few days of combined medical treatment, the urethral catheter is withdrawn after 5 days.
4. Common complications in laparoscopic surgery for kidney stones
Common complications during surgery:
- Torn pleura, perforation of the diaphragm when poking Trocar close to the shore or during surgery. If this accident occurs, the doctor will proceed to stitch the pleura, diaphragm through an endoscopy, combining the continuous suction of pleural circulation. If it cannot be treated with laparoscopic surgery, it can be transferred to open surgery.
- Bleeding due to damage to the lower aortic vein, genital veins due to surgery or slipping clips clamping blood vessels. If the bleeding is not treated through an endoscopy, it will be transferred to open surgery.
- Damage to organs such as the duodenum, colon, small intestine during surgery will be transferred to open surgery for treatment depending on the lesion.
Common complications after surgery are:
- Abdominal bleeding is numerous, unable to hold: the patient needs to be quickly re-operated for treatment.
- Capacitors or abs absss in the abdomen: the doctor will conduct an ultrasound or a computer cirr topect scan to determine the location, size of the volume, absss. If the mass of capacitors, small-sized, shallow-sized prosys will proceed to poke the suction under the ultrasound instructions. If the mass of capacitors, large-sized anesthies, the deep site needs a conductive injection or open surgery for cleaning.
- Patients with post-surgery urine leakage: the patient will be saved the urethra and treated medically. If after 1-2 weeks the condition does not improve, the patient will be reset the JJ cathethe or intervene again.
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