ISSN 2398-2942      

Kidney: surgical approach

icanis

Introduction

  • Four methods of gaining access to the kidneys:
    • Percutaneous blind transabdominal approach (only useful in a limited number of cases in dogs) - suitable for needle biopsy with ultrasound control.
    • Laparoscopic - suitable for biopsy under direct visual control.
    • 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 if the underlying cause cannot be determined otherwise.
    • Abnormal renal size/shape.
    • 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 ispsilateral kidney, especially on left side.
  • Visualization of focal lesions to assist sampling representative area.

Laparoscopic

  • Enhanced visualization Laparoscopy.
  • 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

  • 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 Biopsy: ultrasound-guided.
  • 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.
  • Savvas I, Rallis T, Raptopoulos D (2009) The effect of pre-anesthetic fasting time and type of food on gastric content volume and acidity in dogs. Vet Anaesthes Analg 36 (6), 539-546 PubMed.
  • Watson A D J, Lefebvre H P, Concordet D et al (2002) Plasma exogenous creatinine clearance test in dogs: comparison with other methods and proposed limited sampling strategy. JVIM 16 (1), 22-33 PubMed.
  • Lanz O I, Waldron D R (2000) Renal and ureteral surgery in dogs. Clin Tech Small Anim Pract 15 (1), 1-10 PubMed.

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