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Master R.S., a 3 years old boy was brought with swelling on the left side of his belly for last 6 months. |
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Clinically, the swelling seemed to be from the left kidney and ultrasonogram (USG) showed it to be a Multicystic Kidney - abnormal nonfunctioning kidney composed of a bunch of cysts. |
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The child underwent Laparoscopic Left Nephrectomy (Removal of the kidney). He recovered well and was discharged on day 1 of surgery. |
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Clinical picture showing swelling |
Clinical picture of multicystic kidney |
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Multicystic Kidney and Laparoscopic Nephrectomy |
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Multicystic Kidney disease (MCKD) is a congenital malformation where by the kidney is developmentally abnormal and non-functioning. It looks like a bunch of grapes. Most of the times, MCKD does not require any therapy other than confirming the diagnosis and differentiating it from severe hydronephrosis by a USG and a renal scan. 80% of these kidneys gradually become smaller and disappear by 4-5 years of age. Surgery is indicated only when there is a persistent MCKD or there is a large lump interfering with growth of the baby. |
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Pediatric Laparoscopy or laparoscopic surgery in children is a new and upcoming specialty and it has been possible due to availability of miniaturized equipment, small telescopes and above all well trained doctors. The concept of laparoscopy in children is very appealing and is being applied to more and more surgical problems in kids.
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For laparoscopy, initially a small hole is made in the belly button or navel to put a telescope and also to infuse a harmless gas (generally carbon dioxide) into the belly. This inflates the belly and gives working space to the surgeon. Then through small holes, instruments are put to perform the procedure. These instruments for kids are really small—the tip size is just 3 mm. A camera is attached to the telescope and is used to watch the procedure on a monitor in a magnified and more precise way. At the end of the surgery, the instruments are removed from the belly and one or two stitches are put within the skin to finish the procedure. These stitches need not be removed. It is amazing how extensive procedures can be performed with 3-4 key hole punctures |
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MCKD and other non-functioning kidneys if required to be removed are ideally suited for removal by Laparoscopic surgery if indicated.
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