An Investigation on the Patients Undergoing Kidney Stone Open Surgery: A Single-Center Report From Sistan and Baluchistan Province, Iran

Introduction: Urinary stones are among major urological diseases. Open kidney surgery has always been of historical importance in the management of most urinary stones, especially in complicated cases. The aim of this study was to investigate the cases of open kidney stone surgery in Amir Al-Momenin hospital of Zabol in 2016-2017. Method: In the present descriptive cross-sectional study, the patients who underwent open kidney stone surgery in Amir Al-Momenin hospital were evaluated. The investigated variables included gender, age, changes in blood pressure, postoperative complications, and duration of surgery. The information was collected from hospital records and entered into SPSS software for analysis.Results: In this study, 25 patients were studied, of whom 14 (56%) were females. The mean age of the patients was 37.84 ±17.15 years. The youngest and oldest patients were 1 and 66 years old, respectively. Twelve patients (48%) had staghorn stones, and the rest (13 patients) had other types of stones. Blood pressure remained unchanged in 80% of the patients while 12% developed hypertension. Postoperative fever and infection were observed in only 4% of the patients. The prevalence of staghorn stones in men and women were 45.5% and 50%, respectively. The difference was not statistically significant (P = 0.821).Conclusion: The present study showed that the most common stones leading to open kidney surgery were of the staghorn type. Males were more likely to undergo open kidney surgery than females.

Impact of low-opioid anesthesia on the incidence of postoperative nausea and vomiting during laparoscopic kidney surgery

Background. The problem of postoperative nausea and vomiting has attracted the attention of specialists in various fields of surgery and anesthesiology for a long time and has not lost its relevance today, being the subject of active discussion in domestic and foreign literature. It can become an independent cause of other quite serious postoperative complications. The article presents the results of our own study of the use of multimodal low-opioid general anesthesia as one of the methods for the prevention of postoperative nausea and vomiting during anesthetic provision of laparoscopic kidney surgery. Materials and methods. The study involved 50 patients who underwent laparoscopic kidney surgery. To compare the incidence of postoperative nausea and vomiting, patients were randomly divided into three groups. Group 1 (control group) used multimodal general anesthesia with standard doses of opioids; group 2 used multimodal low-opioid general anesthesia with lidocaine, and group 3 used multimodal low-opioid anesthesia with dexmedetomidine. Results. The total average dose of fentanyl used during the entire time of anesthesia in the control group was 373.3 ± 50.8 μg (4.34 μg/kg/h). The total average dose of fentanyl used during the entire time of anesthesia in group 2 was 217.39 ± ± 49.1 μg (1.76 μg/kg/h). The total average dose of fentanyl used during the entire time of anesthesia in group 3 was 308.33 ± ± 51.49 µg (2.44 µg/kg/h). In group 1, vomiting in the postoperative period occurred in 4 patients out of 15 (26.7 % of cases), in group 2 — in 4 patients out of 23 operated (17.4 % of cases), in group 3 — in 1 patient out of 12 (8.3 % of cases). Conclusions. As a result of comparing the incidence of postoperative nausea and vomiting in the patients of the studied groups, it was found that a decrease in the dose of perioperative use of opioids helps to reduce the incidence of this complication, increases the safety of anesthesia, significantly facilitates and accelerates the rehabilitation of patients after laparoscopic surgery on the kidneys.

Usefulness of Thulium-Doped Fiber Laser and Diode Laser in Zero Ischemia Kidney Surgery—Comparative Study in Pig Model

Background: The aim of this study was to evaluate the usefulness of a thulium-doped fiber laser and a diode laser in zero ischemia kidney surgery, by carrying out a comparative study in a pig model. Material and methods: Research was carried out on 12 pigs weighing 30 kg each. A thulium-doped fiber laser (TDFL) and a diode laser (DL) operating at wavelengths of 1940 and 1470 nm, respectively, were used. The cut sites were assessed both macroscopically and microscopically. The zone of thermal damage visible in the histopathological preparations was divided into superficial and total areas. Results: During partial nephrectomy, moderate to minimal bleeding was observed, which did not require additional hemostatic measures. All animals survived the procedure. On day 0, the total thermal damage depth was 837.8 µm for the TDFL and 1175.0 µm for the DL. On day 7, the depths were 1556.2 and 2301.7 µm, respectively. On day 14, the overall thermal damage depth for the DL was the greatest (6800 µm). The width of the superficial zone was significantly reduced on days 7 and 14 after TDFL application. Conclusion: Both lasers are suitable for partial wedge nephrectomy without ischemia in pigs. The TDFL produced similar or better hemostasis than the DL, with a smaller zone of thermal damage and, therefore, seems more suitable for application in human medicine.

Pathology Associated with Adherent Perirenal Fat and its Clinical Effect

Introduction The dissection of perirenal fat is of critical importance to kidney surgery and ease of dissection is more important when using minimally invasive approaches. This study aimed to determine the clinical, radiological, and pathological significance of adherent perirenal fat(APF). Materials and Methods This prospective study included 22 patients scheduled for partial nephrectomy and 40 patients for donor nephrectomy. Intra-operative fat dissection time was recorded and the complexity of perirenal fat dissection was surgeon-classified as easy, moderate, and difficult. Perirenal fat and subcutaneous fat thickness was measured. Measurement of perirenal fat depth, and the Hounsfield unit(HU) for both perirenal and subcutaneous fields was performed using CT images. All specimens were submitted for histopatological analysis. Researchers in each arm were blinded to other researchers’ data. Results Mean age of the patients was 51.3±12.7years. Mean perirenal fat dissection time was 15.0±13.5min. Patient demographics, BMI, nor occupational status differed between the 3 complexity of perirenal fat dissection groups. Radiological findings showed that there was a significant correlation between perirenal fat depth and complexity of perirenal fat dissection(p<0.05), but not with HU measurements or subcutaneous fat thickness. Surgeon classification of the complexity of perirenal fat dissection was in accordance with the duration of dissection(p<0.05). Perinephric fat contained more fibrous tissue in the patients with histologically proven APF than in those without(p<0.05). Conclusions APF is a challenge during kidney surgery. Difficult dissection prolongs the duration of surgery, which can lead to complications. Perirenal fat thickness measured via pre-operative CT might be used to predict APF.

Multimodal Low-opioid Anesthesia as an Effective Way to Prevent Postoperative Nausea and Vomiting. Pathophysiological Aspects of this Complication

Postoperative nausea and vomiting are common adverse effects of anaesthesia and surgery. Up to 80% of patients may be affected. These outcomes are a major cause of patient dissatisfaction. In addition, postoperative nausea and vomiting can independently cause the occurrence of rather serious complications of the postoperative period, such as aspiration of gastric contents into the airways, hemodynamic disorders in patients with a compromised cardiovascular system, failure of surgical sutures, bleeding, dehydration and electrolyte imbalance which ultimately can lead to disability of patients, prolongation of their hospitalization and higher treatment costs. Material and methods. The paper presents the results of our own research on the use of multimodal low-opioid general anesthesia as one of the methods for the prevention of postoperative nausea and vomiting during anesthetic provision of laparoscopic kidney surgery. The study involved 38 patients who underwent laparoscopic kidney surgery. Results and discussion. To compare the incidence of postoperative nausea and vomiting, patients were randomly divided into two groups. Group 1 used multimodal general anesthesia with standard opioid doses, while group 2 used multimodal low-opioid general anesthesia. The total average dose of fentanyl that was used during the entire time of anesthesia in the control group was 373.3 ± 50.8 μg (4.34 μg / kg / h). The total average dose of fentanyl that was used during the entire time of anesthesia in the study group was 217.39 ± 49.1 μg (1.76 μg / kg / h). In group 1, vomiting occurred in 4 patients out of 15 in the postoperative period, in group 2 there were 4 patients with vomitting, but out of 23 operated patients. The standardized rate of postoperative nausea and vomiting in the control group was 26.6%, in the main group it was 17.3%. Conclusion. As a result of comparing the incidence of postoperative nausea and vomiting in patients of both study groups, we found that a decrease in the dose of perioperative use of opioids helps to reduce the incidence of this complication, which increased the safety of anesthetic management, greatly facilitated and accelerated the rehabilitation of patients after laparoscopic kidney surgery. The work also highlighted and systematized information on the morphology of structures involved in the formation of postoperative nausea and vomiting, on the physiology of this process