Dr. G.Thirumalai Ganesan

MS, M.Ch, FRCS(Glasg), FRCS (Urol)(UK)

Sarayu Medical Center, Q-39, 6th Avenue
Anna Nagar, Chennai-40 (Near K4 Police Station)
Tel: +91-44-45550367/68/69,
+91-97909-60550, +91-98412-33777
Email: endouro@gmail.com

Case Studies

  • No More Open Surgery for Kidney Blockage [Download]
  • Laparoscopic Nephrectomy: Minimally invasive Kidney removal [Download]

No More Open Surgery for Kidney Blockage

Prostate CancerMr SD came with abdominal pain confined to the right side. He underwent tests and this showed that the tube draining the right kidney (ureter) was blocked at the upper part. Before coming to Dr. Thirumalai Ganeshan he went to other hospitals and he was advised open surgery to remove the blockage. Here we offered a key hole procedure and he gladly accepted it. He underwent a microsurgery and was discharged on third post-operative day. He is doing extremely well and there is no more pain.

Mr SD suffered from a condition called PUJ obstruction. The PUJ is the portion of the collection system that connects the renal pelvis (the larger collecting portion of the kidney, which is funnel shaped and tapers down to the ureter) to the ureter. PUJ obstruction is usually congenital (right from birth), but may also be acquired (that is, secondary to other disease processes or previous instrumentation). Many individuals with a PUJ obstruction do not realise they have this condition until later in life, when the poorly flowing urine becomes infected, or they begin developing symptoms such as pain.

A pyeloplasty is a surgical procedure that is indicated for a pelviutereric junction (PUJ) obstruction. Although different types of pyeloplasty operations have been described, the ultimate goal is to remove the strictured portion of the PUJ, fashion the renal pelvis, and attach it to the ureter in a way that allows easy drainage of urine down the ureter.

The standard intervention for pelvi-ureteric junction obstruction is open pyeloplasty. The problem with open surgery is that hospital stay is prolonged, recovery time is too long and the patient will be left with a big and ugly scar. The benefits of laparoscopic pyeloplasty are improved cosmesis, lower morbidity rates and shorter convalescence. Now throughout the world urologists started doing laparoscopic procedure in view of the above mentioned advantages.


Laparoscopic Nephrectomy: Minimally invasive Kidney removal

Mr BP, aged 72 years, from Chennai presented with vague abdominal pain and investigations revealed cancerous tumour arising from left kidney. Further tests were done to rule out any spread outside the kidney. After confirming that the growth was localised to the kidney it was planned to proceed with “keyhole surgery” to remove the kidney. He underwent laparoscopic nephrectomy and was discharged after 72 hours of stay in the hospital.

Laparsocopic surgery is an increasingly used technique in the field of urology in the west. Now, we have introduced this concept in Chennai by establishing a laparoscopic urology programme. The objectives of laparoscopic surgery are to reduce peri-operative morbidity in comparison with conventional surgery and to allow more precise surgery. The quality of surgery can be improved by better visualisation of the operative site which is provided by the optical magnification.

A variety of urologic procedures can be done laparoscopically and laparoscopic nephrectomy is one of the procedures.  Laparoscopic nephrectomy is a minimally invasive procedure and is indicated in patients with an irreversibly damaged, non-functioning kidney and in some kidney cancers. Laparoscopic kidney removal is minimally invasive because it only requires three or four small non-muscle-cutting incisions rather than one large muscle-cutting incision in the abdomen.

Advantages of laparoscopic nephrectomy

  • A shorter hospital stay
  • Significantly less post-operative pain
  • A faster recuperation and earlier return to work and daily activities.

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Comparison

Laparoscopic nephrectomy

Open nephrectomy

Incision

3-4 1.5 cm incisions

15-25 cm muscle cutting incisions

Length of Hospital stay

2-3 days

5-7 days

Recovery

* Less scarring after 
surgery
* Less discomfort and
decreased need for pain
medication

* Increased scarring
* Greater need for pain  
medication

Return to normal activity

2-4 weeks

8-12 weeks


Conclusion

Laparoscopic nephrectomy has already become the standard surgical technique for several kidney diseases in the west. In India too, laparoscopic nephrectomy has begun to replace the conventional open nephrectomy.