Presented to: Dr.

Faisal Kayanni
Presented by:
Surgery of Zeewaqar zafar 49
Sabir Hussain 51
Kidney Abdul Waheed Fatim 54
Hafiz Saeed 56
• Definition
• Surgical Anatomy of kidney
• Indications
• Preoperative concern
• Intraoperative Considerations
• Procedure
• Postoperative
• Definition:
• Nephrectomy: Surgical excision of kidney
• Nephrotomy: Surgical incision into kidney
• Nephrostomy: Creation of permanent fistula leading into kidney
• Preoperative concern:
• Renal diseases trauma, obstruction
• Acute or chronic renal failure
• Measurement of BUN, P, Ca, Creatinine, hematocrit, total protein, albumin,
electrolyte(K), Co2 level
• Azotemia
• Hyperkalemia
• CKD
Anatomy
• Kidneys lies in retroperitoneal space later to aorta and caudal vena cava
• Fibrous capsule
• Kidneys held by Sub peritoneal Connective tissue
• Innervation: The efferent sympathetic renal nerves are distributed to all segments of the
intrarenal vasculature in the renal cortex and outer medulla, including the interlobar, arcuate, and
interlobular arteries and the afferent and efferent glomerular arterioles.
• Blood Supply:
• Renal Artery: The renal arteries normally arise off the side of the abdominal aorta, immediately
below the superior mesenteric artery, and supply the kidneys with blood.
• Renal Vein: The renal veins are veins that drain the kidney and they connect the kidney to the
inferior vena cava.
• Renal Plexus: The renal plexus is formed by filaments from the celiac plexus, the aorticorenal
ganglion, and the aortic plexus.
Intraoperative Considerations
• Induction: Dehydrated: Etomidate, Propofel
Hydrated : Propofel
Maintenance: Fentanyl, Fentanyl CRI,
Hydromorphine or Bupernomorphine
Ketamine low dose 0.5 – 1 mg/kg I/V
Hypotension: Dopamine
Blocks: Epidural: Morphine Incissional: Lidocaine,Bupivacaine
Indications
• Renal Neoplasia
• Uncontrolled hemorrhage
• Persistent urine leakage
• Pyelonephritis
• Hydro nephrosis
• Calculi formation
• Stone formation
• Hyperkalemia
• CKD (chronic kidney Disease)
Procedure
Procedure
• Anesthesia
• Incisions
• (a) Clipping of renal vein tributary, (b) Clipping of all right renal veins
• tying of Right renal artery
• Clipping of renal artery
• Cutting renal veins with harmonic
• Clipping of all renal veins
• Dissection of ureter with lower pole
• Dissection of upper pole near liver
• Renal hilar vessels clipped and divided
Postoperative
• Analgesic: Fentanyl, Morphine, Hydromorphine
• NSAIDS are contraindicated
• Antiobiotics: Ampicillin 22mg/kg IV, IM, SC
• Amoxicillin plus Cl avulanate (clavamox)
• cefazolin(ancef, kefzol)
• Cephalexin
• Enrofloxacin 5mg/kg