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Medical Center Teknon

Marquesa surgery
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LAPAROSCÒPIA | lumbar flank surgery

The deep situation of the kidney in the lumbar flank, under the last ribs, makes all traditional approaches precise large incisions for good access. Here the advantages of laparoscopy are uncontested, being currently on debate if laparoscopy should be not an option but a must in most renal surgery. That is the fact today for the surgery of the adrenal gland, situated on top of the kidneys, and that due to their small size may be extracted through a trocar site, without any extra incision.

Lap radical nephrectomy is the surgical procedure undergone to extirpate a diseased kidney. With the laparoscopic technique, the renal artery is ligated by means of haemostatic clips and the renal vein also with clips or with a laparoscopic stapler. In the traditional approach, the usual incision follows the line of the last rib for accessing the kidney. That wound is painful and with a long convalescence. In the laparoscopic approach, the wound needed to extract the kidney is much smaller and may be moved to a less painful location, with better recovering. Surgical bleeding tends to be minimal.

Regretfully not all renal tumors may be intervened by a laparoscopic approach. Big size tumours, with neighbor organ affection or the ones affecting large vessels (renal vein or vena cava) may still need an open approach.

Increase in the usage of imaging techniques (ultrasonography, CT scan...) to evaluate diverse pathologies has increased casual discovering of small renal lesions. These inciental lesions, often in young asimptomatic patients have made us develop minimally invasive therapies able to preserve the remaining healthy kidney.  Laparoscopic partial nephrectomy allows tumor extirpation, pathologic assesment, and cure rate equivalent to complete nephrectomy.

Time has demostrated that this technique is not only equivalent in tumor survival but, as it keeps more renal parenquima, increases global survival because it prevents renal insuficiency.
Laparoscopic partial nephrectomy is a complex technique and includes renal pedicle identification, temporal occlusion and lesion exeresis together with kidney reconstruction in minimal time.

The kidney tolerates without lesions ischemia time up to 30 minutes, which implies a surgical procedure with exquisite time control. This time limitation makes the technique so complex than multiple or tumors with difficult reconstruction cannot be undergone by this technique. Sometimes the same technique can be used in the treatment of non-tumoral lesions as in lithiasic partial nephrectomies.


" advantages of laparoscopy are uncontested, being currently on debate if laparoscopy should be not an option but a must in most renal surgery "