Thanks to advancements in technology operations can now be done with very small incisions. In percutaneous kidney surgery, the kidney is entered directly through a 1 cm incision to break apart and remove large stones.
Percutaneous surgery, a unique method that is practiced in removing stones larger than 2 cm, is recently being used with increasing frequency. Acibadem Fulya Hospital Urology Specialist Prof. Dr. Sinan Zeren, who pointed out that percutaneous surgery started being used towards the end of the 70s, said “Once the method of breaking apart kidney stones by shock waves from outside the body was developed in the 80s it was thought that surgery was no longer needed. But over the years it was discovered that the method of using shock waves was not suitable for every patient and that several sessions needed to be applied to patients with many hard stones, which was putting extra wear on the kidneys, so some restrictions were placed on this method. Percutaneous surgery came to the agenda for patients with multiple and hard stones that could not be treated by shock wave therapy and became more widespread in our country as well in the 2000s. Another method for treating kidney stones is by entering the kidney via the urinary tract and breaking apart the stones by laser. However the most suitable method for stones larger than 2 cm is percutaneous surgery”.
How is it Different from Laparoscopic Surgery?
Prof. Dr. Zeren explains the difference between laparoscopic surgery and percutaneous surgery as follows: “Depending on the type of operation, several ports (tubes) are placed for laparoscopic surgery and whatever is done in open surgery is done on the outer wall of the kidney. In percutaneous surgery the tube is placed directly inside the kidney and the process is done inside the kidney.”
What disease treatments is it used for?
Prof. Dr. Zeren, who explained that percutaneous kidney surgery is generally used for treating kidney stones and called a percutaneous nephrolithotomy, gave the following information about the other fields of use: “Percutaneous surgery is also used to open up tightness in the outlets of the kidneys or in the openings of kidney chambers and the endoscopic removal of tumors from the reservoirs of the kidneys in suitable patients.”
How is it applied?
Accepted as an ideal form of treatment for patients with large kidney stones, percutaneous kidney surgery involves placing the patient face down on the operating table and making a 1 cm incision on the side of the back. The kidney is entered through a tube that is inserted into the kidney from here. The kidney chambers are accessed through an optic tool called a nephroscope that is sent through this tube. The stones are broken up with tools that are sent through the tube and the pieces are removed with forceps. During the procedure the area is checked by x-ray and endoscopic examination to make sure it is clear and a catheter called a nephrostomy is installed to monitor the urine color and discharge. After the radiographies taken the next day to check the situation the catheter is removed, the incision site is checked and the patients are usually discharged within 24 hours. Prof. Dr. Zeren explained that they usually prefer the patient to spend two nights in the hospital so they can make sure they have recovered. Upon discharge the incision site of patients is usually without stitches or dressing and in condition to be able to take a bath and they can usually return to their normal lives within 7-10 days. Percutaneous kidney surgery can be applied to both kidneys at the same time if the patient’s condition is suitable.
Experience is important in specific situations
Because every kidney and the structure of every stone are different, this procedure must be done by a highly skilled surgeon. It is particularly vital that percutaneous surgery be performed by experienced urologists in patients with special conditions like having a single kidney, having problems in both kidneys, babies, children and elderly patients, patients with large stones, patients with stones that do not look clearly in x-rays, patients who have had operations in the same area before and patents with horseshoe kidneys (kidneys that are conjoined by birth).
In rare situations when kidney stones cannot be accessed through a single incision a second incision may need to be made. However Prof. Dr. Zeren pointed out that the special devices with movable tips being used presently are highly successful in solving the problem through a single incision.