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Keyhole Surgery (PCNL)

Keyhole Surgery (PCNL) in Delhi

Keyhole Surgery (PCNL)

Keyhole Surgery in Delhi

Overview

Keyhole Surgery (PCNL) is a well-established procedure by which stones in the kidney or the upper ureter are removed by making a small incision in the flank. Generally, an incision, that is 1 cm or less than 1 cm, is made in the flank. A guide wire is passed through this incision into the kidney. Keyhole Surgery is performed under fluoroscopy or x-ray control

Advantage & Other notes

The main advantage of this approach is that, unlike traditional open surgery, only a 1 cm incision is made in the flank. The stones can be visualised directly and removed. Unlike ESWL or ureteroscopy, the stones are removed in the same sitting and the kidney is cleared of calculi. The stay in the hospital is only for 3-4 days.

  • This surgery would be recommended as a treatment of choice, if the patient has kidney stones larger than 2 cm
  • This procedure is commonly performed under general anaesthesia, and therefore you also need to be admitted to the hospital for this procedure.
  • The success rate of clearance of stones with this procedure ranges between 90 to 95%. This actually depends upon the size, number and location of these stones. Sometimes, complete clearance may require a second procedure after a few days.
  • For the post-operative course, the patient will generally need to stay in the hospital for 2 to 3 days after the procedure. He or she will also undergo additional x-rays or ultrasound studies, to determine if there are any residual stone fragments present.
  • Rare complications include persistent uncontrolled bleeding due to arteriovenous malformations or pseudo-aneurysms (0.4%), which would need secondary procedures. When a supracostal puncture (above the 12th rib) is made, complications would then include pneumothorax (commonly called collapsed lung caused due to the accumulation of air or gas in the space surrounding the lungs) or fluid accumulation in the thorax. Again, the incidence of these is only 0-4%.
  • The time by which a patient can get back to work would depend upon the magnitude of the stone burden and the number of tracts made. Most patients return to average activity levels within a week or so. A return to vigorous activity should probably take place after 4 weeks.

More about Keyhole Surgery & its applications

Keyhole Surgery can be performed in the case of Crohn's disease, gastrointestinal problems, Appendicitis, Ovarian cyst, Ectopic pregnancy, endometriosis, pelvic inflammatory diseases and other diseases that require surgery. To achieve optimum results the team of the doctors need perfect coordination to perform the keyhole surgery and the process calls for spatial awareness, sharp eye to notice accurately the developments on the screen from various angles and an ability to develop a deep perception about the next steps to be followed and the risk management similar to the general surgeries.

The process of keyhole/laprascopic surgery has been made further simplified by specialized tools for decades, for example, TransEnterix (Durham) and SPIDER Surgical System. Some modern electronic tools developed to aid surgeons have the features such as visual magnification, stabilization of the patient's body as well the set up during operation, simulators to improve the proficiency of surgeons and last but not the least decreased number of incisions caused to the patient.

Robotic keyhole surgery has been emerging as a solution to the pertaining problem of lack of health care in the underdeveloped nations. This type of modern surgery can equip one central hospital to operate several machines from far off locations and treat the patients. This development in keyhole surgery holds potential for extensive usage in military as well. The non- robotic assistance devices are showing up as a promising system to increase the success rate of the keyhole surgeries.

Though the keyhole surgery is known for no pain and easy recovery it is good to be aware about some of the risks that one poses oneself if choosing to be operated in this way. Some of the risks are burns caused on the surrounding tissues due to the electric devices used during the operation, hypothermia, inability to tolerate the gas in the abdominal cavity that may lead to switching over to the open surgery.

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