[General Surgery Laparoscopy] 4K ultra-high definition laparoscopic renal pedicle lymphatic ligation

Renal pedicle lymphatic ligation is a widely used method with certain efficacy in the treatment of chyluria. The lymphatic drainage of the kidney can be divided into 3 groups: perirenal fat, renal capsule, and renal parenchyma. The three groups of lymph merge into several main trunks at the renal hilum, and then return through the lumbar trunk. Therefore, ligating lymphatic vessels at the renal pedicle blocks three groups of channels, which plays a better role in improving lymphatic system dynamics disorders.

Causes of chyluria

Chyluria is a clinical disease caused by lymphatic vessel obstruction due to various reasons, such as filarial infection, tumors, tuberculosis, surgery, trauma, etc., and chylofluid entering the urine. It is common in my country's relatively backward economy, which is mainly based on rice cultivation. Patients who have lived in southern agricultural areas for a long time. High-fat and high-protein diet, overwork, and colds are common causes of its onset.

Symptoms of chyluria

The urine of patients with chyluria can be typically milky white, or it can be white turbidity, yellow turbidity, or chylohematuria. It is often accompanied by unilateral or bilateral low back soreness or dull pain. Sometimes the ureter may be blocked by chyloclots or blood clots. Causes renal colic, difficulty urinating, or urinary retention. If chyluria is not relieved or effectively treated, it can lead to recurrent renal colic, nutritional problems due to protein loss, and immunosuppression due to lymphocyturia.

Treatment method: Currently, the most effective clinical method for treating chyluria is renal pedicle lymphatic ligation. Accurate treatment of the lymphatic vessels around the renal pedicle blood vessels during the operation is the key to the success of the operation. With the continuous development of minimally invasive surgical techniques, retrolaparoscopic renal pedicle lymphatic ligation for the treatment of chyluria has gradually matured.

Surgical advantages: Compared with open surgery, laparoscopic surgery has the advantages of less surgical trauma, faster postoperative recovery, and shorter hospitalization time.

Chyluria prevention

Eat a reasonable diet and strengthen exercise to improve your body's resistance and immunity.

Avoid traveling to areas with a high risk of filariasis. Once an infection occurs, it must be treated promptly.

If you live in an area with a high incidence of filarial worms, you should take effective measures to repel and avoid mosquitoes, such as using mosquito nets, insecticides, and repellents.

Laparoscopic renal pedicle lymphatic ligation surgery

The extraperitoneal fat is removed to expose the perinephric fascia, the perinephric fascia is opened longitudinally to expose the fat sac, and the kidney and fat sac are completely separated along the surface of the kidney.

Disconnection of the renal pedicle blood vessels and lymphatic vessels around the upper segment of the ureter: Bluntly separate the right renal artery between the outside of the fat sac and the psoas muscle, bluntly separate the lymphatic vessels around the renal artery, and slowly cut off the lymphatic vessels around the renal artery with an ultrasonic scalpel. Cut the outer sheath of the artery to free about 2cm of the artery, continue to separate the renal pedicle, expose the renal vein, bluntly separate the lymphatic vessels around the renal vein and disconnect the lymphatic vessels. The lower pole of the kidney is lifted up, the upper segment of the ureter is separated between the lower pole of the kidney and the psoas muscle, and the surrounding lymphatic vessels are separated and severed.

The lymphatic vessels on the dorsal side of the renal vein are separated and severed, and the upper pole of the kidney is fixed. Two renal arteries were freed. Two renal veins were freed. Dissociate and identify the lymphatic vessel between the two veins. The retracted lymphatic stump deep in the renal pedicle was found and clamped with biological clips. The left renal pedicle was completely mobilized.