Lap nephrectomy case ppt
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Dr. Sarwar, resident urologist at JPMC, saw a 54-year-old female with a 1.5 month history of left flank pain radiating to the groin. CT and diagnostic tests found a hydronephrotic left kidney with ureteric stricture. A MAG-3 scan after stenting showed non-function of the left kidney, so the patient underwent laparoscopic left nephrectomy.
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Lap nephrectomy case ppt
- 1. MAHAR NAVEED SARWAR RESIDENT UROLOGIST WARD # 19, JPMC
- 2. 54 years old female known hypertensive, presented to us with c/o Pain in left flank region for 1.5 months Dull aching pain in left lumber region that was radiating towards ipsilateral groin. It was not associated to any other symptom, it had no aggravating or relieving factors.
- 3. Old age female of average height and built, well oriented to time person and place Vitals: •Pulse = 87/min •B.P = 140/90mmhg •R/R = 18/min •Temp = 98.6:F Sub-vitals: Anemia = absent Jaundice = absent Cyanosis = absent Clubbing = absent Dehyd: = absent L/Nodes = N/P Edema = absent
- 4. Inspection: ◦ Flat with centrally placed inverted umbilicus, moving symmetrically with respiration. ◦ No visible pulsation, vein or scar mark Palpation: ◦ Soft, non-tender no visceromegaly or ascites Percussion: ◦ Tympnytic overall Auscultation: ◦ Audible bowel sounds with no added sounds
- 5. Normal hematological and coagulation studies Renal profile was also within normal limits CT-KUB: ◦ Left hydronephrotic kidney with thinned out cortex Diagnostic URS: ◦ Mid ureteric stricture ( JJ stenting done) MAG-3 scan (1 month after JJ stenting) ◦ Left non-functioning kidney
- 8. transperitoneal laparoscopic nephrectomy with conventional 4 ports Colon is mobilized by incising line of toldt
- 9. Spleen is mobilized towards medial side Ureter identified along the lateral border of psoas muscle Renal hilum and renal vessels identified ligated Kidney removed by lateral extension of 12 mm port incision