Our Summary
This research paper examines different surgical methods for removing a kidney (nephrectomy) in children. The study focused on comparing minimally invasive methods (which use fewer and smaller incisions) and traditional open surgery. It looked at four different methods: single-instrument retroperitoneoscopic (SIRP), two-instrument retroperitoneoscopic (TIRP), transperitoneal (TP), and the open approach.
The authors reviewed the medical records of children who had this surgery at one hospital between January 2009 and January 2020. They excluded cases where other procedures were performed at the same time, incomplete records, or where only part of the kidney was removed.
The main things they looked at were how long the operations took, complications during and after surgery, and how long the child had to stay in the hospital.
They found that the length of the operation and the hospital stay were roughly the same across all methods. However, complications during surgery were significantly more common with open surgery. After surgery, complications were rare but did occur in the open surgery group.
In the minimally invasive groups, there were no cases where surgeons had to switch to an open surgery. However, in the TP group, this happened in 5.4% of the cases.
The paper concludes that minimally invasive methods for kidney removal in children are safe and do not take more time than open surgery. They also lead to fewer complications.
FAQs
- What were the four surgical methods for kidney removal compared in the study?
- What were the main factors examined in the study to compare these surgical methods?
- Based on the study, what are the advantages of minimally invasive methods over open surgery for kidney removal in children?
Doctor’s Tip
A doctor might tell a patient that minimally invasive methods for nephrectomy are safe and lead to fewer complications compared to traditional open surgery. They may also explain that the length of the operation and hospital stay are similar across all methods, but complications during surgery are more common with open surgery. Lastly, they may mention that in the minimally invasive groups, there were no cases where surgeons had to switch to open surgery, while this occurred in some cases with the transperitoneal approach.
Suitable For
Patients who are typically recommended nephrectomy include those with kidney cancer, severe kidney damage or dysfunction, kidney stones that are causing severe pain or infection, kidney infections that are not responding to other treatments, and traumatic injury to the kidney. In children, nephrectomy may also be recommended for certain congenital conditions such as multicystic dysplastic kidney or Wilms tumor.
Timeline
Before nephrectomy, a patient typically undergoes a series of tests and examinations to determine the need for surgery and assess their overall health. This may include blood tests, imaging studies such as CT scans or MRIs, and consultations with various specialists.
On the day of the surgery, the patient will be admitted to the hospital and prepared for the procedure. This may involve fasting, receiving medications, and undergoing anesthesia.
During the nephrectomy, the surgeon will remove the affected kidney through either an open or minimally invasive approach. The surgery may take several hours, depending on the method used and the complexity of the case.
After the surgery, the patient will be closely monitored in the recovery room before being transferred to a hospital room. They may experience pain, require pain medications, and be encouraged to move around to prevent complications such as blood clots.
The patient will typically stay in the hospital for a few days to a week, depending on their recovery progress. They will be advised on post-operative care, including wound care, activity restrictions, and follow-up appointments.
In the weeks and months following nephrectomy, the patient will gradually recover and resume their normal activities. They may need to undergo physical therapy, adjust their diet, and monitor their overall health to ensure the remaining kidney functions properly.
Overall, nephrectomy is a major surgery that requires careful preparation, skilled surgical techniques, and diligent post-operative care to ensure a successful outcome for the patient.
What to Ask Your Doctor
Some questions a patient should ask their doctor about nephrectomy based on this research paper include:
- What are the different surgical methods for nephrectomy, and which method do you recommend for my child?
- How long does each type of surgery typically take?
- What are the potential complications during and after surgery for each method?
- How long is the expected hospital stay for each method?
- Have you had experience performing nephrectomies using minimally invasive methods?
- What is the likelihood that the surgery will need to be switched to an open approach during the procedure?
- What post-operative care will be needed for my child depending on the surgical method used?
- Are there any long-term effects or considerations to be aware of for each surgical method?
- What is the success rate or outcomes for each surgical method in terms of removing the kidney effectively?
- Are there any specific factors about my child’s health or condition that may influence the choice of surgical method for nephrectomy?
Reference
Authors: Mosa H, Giannettoni A, Patil K, Mishra P, Taghizadeh A, Paul A, Garriboli M. Journal: J Laparoendosc Adv Surg Tech A. 2021 Dec;31(12):1466-1470. doi: 10.1089/lap.2021.0343. Epub 2021 Nov 26. PMID: 34847738