Chinese medical team at the Zanzibar Mnazi Mmoja Referral Hospital in collaboration with the local doctors have recently performed successful two complicated nephrectomy procedures on two patients who were clinically found with kidney problems.
A 63-year-old male reported to the urology clinic complaining left back pain. B-ultrasound and CT showed severe hydrops in the patient’s left kidney, atrophy of the left kidney with no function and inflammation around the kidney.
The other patient was a 37-year-old female admitted at the hospital with painful huge mass in her left abdomen.
CT showed a huge space in the left kidney. The tumor with a large diameter of over 30cm, considered to be cancer, occupied the entire kidney and oppressed the surrounding organs. The renal vein was suspected of having cancer thrombi.
The surgeries for the two patients were reportedly difficult. Before the operation was performed, the medical team conducted detailed discussion led by Dr. Qu Lishuai, the team leader. Other members of the team were Dr.Hualei, urologist, Dr. Chen Hongsheng, anesthesiologist, Dr. Liu Tingting, radiologist, Dr. Liu Donghua, acupuncturist and Song Jianqing, the interpreter brainstormed on the difficulties of the operations and solutions to them and finally reached a consensus.
While the two patients had clear indications for surgery, the surgical risk was high, which required a multi-disciplinary cooperation to secure a complete success.
After discussion and analysis, Dr. Qu Lishuai, the team leader, Dr. Li Hualei, urologist exchanged information with Dr. Makame Omar, Dr. Hokam Chau, and Dr. Hassan Mkoko from the Hospital’s Urology Department.
Communication with patients and family members
Members of the medical team communicated effectively with the two patients and their families and informed them of the operations to ensure that doctors and the patients were fully prepared.
Relevant laboratory examinations were completed before the surgeries; relevant preoperative assessments were made; and transfusion blood balance was checked on the day of surgery.
Meanwhile, the surgical plan and the treatment of related complications were discussed with Chinese urology experts through the Internet.
Finally, an optimal surgical plan was customized for the two patients respectively, based on a careful weighing of the pros and cons of various surgical methods, and the consideration of the current conditions at Mnazi Mmoja Hospital.
Surgery for patient with hydronephrosis
For the patient with hydronephrosis, a retroperitoneal laparoscopic approach was adopted. On the waist of the patient, two 1cm incisions and one 0.5cm incision were made. Three trocars were placed around the kidney to establish three artificial channels, through which medical carbon dioxide was continuously injected to maintain sufficient pressure behind the peritoneum.
After the introduction of the endoscopic television system and the instrument operating system, the kidney was removed.
Due to the severe adhesion of the tissues around the atrophic kidney, the huge changes in the morphology of the kidney and renal blood vessels, and the difficulty for dissection, this surgical method had the characteristics of being minimally invasive with an enlarged and clear visual field. Compared with traditional open surgery, retroperitoneal laparoscopy has smaller wounds, does not need to enter the patient’s abdominal cavity, and has the advantages of less shock and traumatic response to the patient’s operation, and quicker recovery after surgery.
In addition, the laparoscopic lens has a magnified field of view, allowing surgeons to observe the local tissue structure more carefully and accurately.
It can directly visualize the anatomical structure of fine blood vessels and the exposure of nerves under the laparoscope, avoid the appearance of lateral damage, and even achieve some finer functional preservation.
For some parts that are not easily exposed, the lesion can be directly seen through the endoscope, which is helpful for the sound judgment of the patient’s condition and the proper evaluation during the operation.
Surgery for kidney cancer patient
For the kidney cancer patient, an open transabdominal approach was adopted. An arc-shaped incision was made under the costal arch, and the peritoneum was cut to reach directly the surface of the tumor.
The surface of huge kidney cancer was rich in blood supply, large in size and adherent to surrounding tissues. Severe complications such as hemorrhage, spleen loss, pancreatic injury, and bowel injury occurred during such surgery.
While the surgical method adopted was more traumatic, the surgical field was clearly exposed, and the operation under direct vision was safer and more convenient.
Why the operations were necessary
Why do these two patients with completely different diseases needed nephrectomy? Normally the prolonged water accumulation in the kidneys causes excessive pressure in the kidneys and compresses them to make their parenchyma thin. Finally, the renal parenchyma is squeezed into a sac and loses its function. This change is irreversible.
Because stagnant water cannot be excreted from the body, and the body’s resistance declines, it will cause kidney infection in time, and patients may experience symptoms of septic shock such as high fever and chills. Therefore, even benign lesions require surgical removal of the diseased kidney.
Once kidney tumors were diagnosed, in most cases malignant, surgery was required.
Patients with larger tumors often undergo radical nephrectomy. If the tumor is smaller than 5 cm, partial nephrectomy can be done as per specific situations.
CT showed that the above-mentioned female patient’s tumor was huge and compressed to the abdomen. The mass could be felt clearly through palpation on the abdomen, and the patient felt severe pain when pressed. Clinically, the renal cancer was considered to be stage 3 and must undergo radical renal cancer surgery.
Dr. Chen Hongsheng, said the patient had a huge kidney cancer and the operation would be difficult.
“In order to prevent major bleeding, general anesthesia was used. Immediately before the operation, about 1500 ml of crystal fluid was quickly refilled and colloidal fluid was prepared to be quickly refilled during bleeding to reduce blood transfusion,” he said.
“At the same time, vasoactive drugs were prepared to maintain the vital signs during the operation. As the tumor had abundant blood supply and strong adhesion to the blood vessels, and there was much blood oozing when the tumor was isolated, it was necessary to replenish colloidal fluid and crystal fluid in tim,” he added.
“Through intravenous infusion of whole blood, and vasoactive drugs used to maintain stable vital signs when necessary, a patient could survive the operations. It is my job to be the guardian of life for patients during the operation,” he said.
Dr. Makame Omar, Senior Consultant Surgeon and Dr. Makame Omar, Senior consultant surgeon at the hospital commended the cooperation and joint efforts of the Chinese medical team and the local medical doctors in serving patients.
“The Chinese and local surgeons accumulated experience in diagnosis and treatment of renal diseases and improved confidence for performing complex nephrectomy,” said Dr. Makame.
He appreciated the knowledge and skills imparted by the Chinese medical team in which the two operations were carefully arranged and performed successfully.