Precautions during nephrectomy for patients with renal cancer

Nephrectomy is a commonly used treatment for renal cancer. To achieve the greatest therapeutic effect, the resection principles must be strictly followed during the operation.

1. When incising and separating the transverse abdominal fascia and the perinephric fascia, be careful not to damage the ilioinguinal nerve, iliohypogastric nerve, or tear the peritoneum.

2. If the adhesions are tight and separation outside the renal capsule is difficult, subcapsular nephrectomy can be performed, but care must be taken to avoid cutting into the diseased renal parenchyma.

3. Before clamping the renal pedicle, check whether the renal pedicle forceps are secure. Clamping the renal pedicle forceps should be done under direct vision or at least under the guidance of finger touch, and never clamp nearby important tissues at the same time.

4. After the kidney is exposed, the gross pathology of the kidney and ureter should be noted. If the ureteral appearance is normal or the pathological morphology of the kidney is inconsistent with the X-ray film, it should be carefully verified to prevent the occurrence of miscutting accidents.

5. If the lesion of the diseased kidney is a tumor, the perinephric fascia should not be incised during surgery. The kidney should be separated outside the perinephric fascia, and the perinephric fat, perinephric fascia and local lymph nodes should be removed in one piece.

6. When separating the ureters, do not damage the spermatic cord (ovarian) blood vessels that run parallel to the ureters. If damaged, they should be ligated immediately to avoid bleeding during and after the operation.

7. If the kidney lesion is a renal pelvic tumor, the kidney, the entire length of the ureter, the pararenal tissue and the lymph nodes should be removed in one piece, and part of the bladder around the ureteral opening should also be removed.