수술실 간호사가 정리한 신장절제술 laparoscopic nephrectomy 수술개념 및 수술과정 A-Z

문서 내 토픽

1. Laparoscopic Nephrectomy ANATOMY

신장(콩팥)을 제거하는 수술로 주로 RCC(Renal cell carcinoma) 환자에게 적용한다. 신장제거술에는 전절제술과 부분 절제술이 있다. Abdominal aorta와 Inferior Vena Cava(IVC)는 각각 상대적으로 우리몸의 좌측, 우측에 위치한다. Artery는 Abdominal aorta에서 Renal artey로 좌우 모두 분지가 되고, Renal artery에서 adrenal artery등이 분지된다. Vein은 우측신장이 가깝기에 Renal vein도 우측이 좌측보다 짧다. 또한 주의깊게 여겨보아야할 점이 바로 Adrenal vein과 Gonadal vein이다. 우측은 Adrenal vein과 Gonadal vein이 IVC에서 직접 분지하지만, 좌측은 Renal vein에서 분지되는것이 특징이다. Gonadal vein 아래에는 Ureter가 있어 쉽게 확인이 가능하여 operate가 가장 먼저 찾는 gateway이다.
2. Laparoscopic Nephrectomy 수술 준비물

ST, 종지, 캔, bowl, plate, 스틱자세트, URO Lapa set, major, bulldog, s tonsil, s rt angle, MD, 헤모락 초록(5mm).보라,골드소모품, 니들 보비팁, medium 보비팁(BLM), 보비부츠, 젤포트 준비, 젤리많이필요, 더블 7 glove, S/M POUCH, endo stapler Echelon 45/60 white, scope10mm, light cable 세팅, 리가슈어 세팅, bovie ower 30-30-30, 에어 매트리스, 수술부위 Rt면 스콥장비도 환자의 rt.에 위치, bleeding control 재료(젤폼,써지셀 큰 것, 타코콤(S), styp seal, geen plast 2ml, FLOSEAL**STYP, GEEN), 복강경 tip도 같이 준비!
3. Laparoscopic Nephrectomy 수술 과정

troca : drape -> m-pen -> blade 픽업 ->보비 -> 시스만 있는 12mm troca-> CS-10M tagging suture-> 칼 보비 12mm troca -> 칼 보비 5mm troca -> CO2 on, 무영등 OFF, 포지션 체인지 (수술부위가 RT일 경우 RT UP), renal artery 찾기: ligasure, suction 라인 꼬이지 않게 바울 그라스퍼(기본 작은거), 헤모락 작은거, 클립 5mm, 보락 hemolock 준비, 혈관 박리 끝난 후 MASS 드러남 : vein artery 찾아-> 5mm troca 하나 더 사용 -> 젤포트, 종지에 젤리준비, 초록장갑 왼손만 씌움 -> 젤폼 + 써지셀 묶음 만들기 GS65M 사용 -> V- LOCK 준비 -> 불독 clamping -> 시간카운트 10분마다 하기, MASS excision : 바울 그라스퍼로 mass 잡아서 ligasure / 엔도보비시저 (세트꺼X) & 훅 도려내기 -> pouch에 mass 담고 밖으로 나오면 종지에 옮기기 이때 중요한 것 !!! 4*4거즈 input out put 종이에 표시함, Suture : 그라스퍼 -> 니들홀더& v-lock -> 시저 -> subcu V/C 슈처 1,2,3, DRESSING : 스테이플러 12?15 1개 꼬맹이 두개 테가덤 4

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1. Laparoscopic Nephrectomy ANATOMY

Laparoscopic nephrectomy is a minimally invasive surgical procedure used to remove the kidney. The anatomy involved in this procedure is critical for a successful and safe operation. The key anatomical structures include the kidney, ureter, renal artery and vein, and surrounding tissues and organs. Understanding the precise location, size, and relationships of these structures is essential for the surgeon to navigate the surgical field, identify and isolate the kidney, and safely ligate and divide the vascular and ureteral structures. Careful preoperative imaging and intraoperative visualization are necessary to map out the anatomy and avoid complications. The surgeon must have a thorough understanding of normal kidney anatomy as well as common anatomical variations that may be encountered. Meticulous dissection and attention to detail are critical to minimize the risk of bleeding, ureteral injury, or damage to surrounding structures during the laparoscopic nephrectomy procedure.
2. Laparoscopic Nephrectomy 수술 준비물

The successful performance of a laparoscopic nephrectomy requires the appropriate surgical instruments and equipment. Key items include high-definition laparoscopic cameras and monitors, specialized laparoscopic instruments such as graspers, dissectors, and staplers, energy devices for tissue dissection and hemostasis, suction/irrigation systems, and adequate lighting. Proper patient positioning, padding, and access to the surgical field is also crucial. The surgical team must be well-trained and experienced in laparoscopic techniques, and the operating room must be set up efficiently to facilitate a smooth and safe procedure. Careful preoperative planning, including selection of the appropriate surgical approach and port placement, is essential. Adequate backup equipment and a plan for conversion to open surgery must also be in place in case of intraoperative complications or difficulties. Attention to detail in the preoperative setup and preparation is key to optimizing outcomes for the patient undergoing laparoscopic nephrectomy.
3. Laparoscopic Nephrectomy 수술 과정

The laparoscopic nephrectomy procedure involves several key steps. First, the patient is placed in the appropriate position, typically in a lateral decubitus position, and the surgical field is prepped and draped. Small incisions are made to allow for the insertion of the laparoscopic ports and instruments. The surgeon then carefully dissects and mobilizes the kidney, identifying and isolating the renal artery and vein. These vascular structures are then ligated and divided, allowing for the kidney to be removed. The ureter is also identified and divided. Throughout the procedure, the surgeon must maintain meticulous hemostasis and carefully monitor for any bleeding or other complications. Once the kidney is fully mobilized, it is placed in a retrieval bag and removed through one of the port sites. The surgical site is then inspected, any bleeding is controlled, and the incisions are closed. The entire procedure is performed using minimally invasive laparoscopic techniques, which can offer benefits such as reduced pain, shorter hospital stay, and faster recovery compared to open nephrectomy. However, the laparoscopic approach requires advanced surgical skills and experience to execute safely and effectively.

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2025.01.20 · 의학/약학