Open Kidney Surgery: Difference between revisions

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==== Pre-operative considerations ====
==== Pre-operative considerations ====
* '''<span style="color:#ff0000">Anticoagulation</span>'''
* '''<span style="color:#ff0000">Anticoagulation</span>'''
** '''<span style="color:#ff0000">Intravenous or low-molecular-weight heparin should be started as soon as tumor thrombus is detected</span>'''
** Patients with kidney cancer are at increased risk of pulmonary embolism as a result of malignancy-associated hypercoagulability and venous thrombus embolization.
**Patients with renal tumors are at increased risk of pulmonary embolism as a result of malignancy-associated hypercoagulability and venous thrombus embolization.
**'''<span style="color:#ff0000">Intravenous or low-molecular-weight heparin should be started as soon as tumor thrombus is detected</span>'''
** Although evidence supporting the use of preoperative anticoagulation is limited, several potential benefits include reduced risk of pulmonary embolism, tumor thrombus shrinkage, and bland thrombus shrinkage and/or prevention.
***Potential benefits (3):
**Temporary suprarenal IVC filters are also an option for patients with level 0, I, and II tumor thrombi. However, because of the risk of contralateral renal and hepatic vein thrombosis, the risk of provoking embolization, and the impediment that these devices can pose to future IVC thrombectomy, suprarenal IVC filters are not recommended.
***#Reduce risk of pulmonary embolism
***#Tumour thrombus shrinkage
***#Bland thrombus shrinkage and/or prevention
***Evidence supporting the use of preoperative anticoagulation is limited
***Temporary suprarenal IVC filters are also an option for patients with level 0, I, and II tumor thrombi. However, suprarenal IVC filters are not recommended because of the risk of contralateral renal and hepatic vein thrombosis, the risk of provoking embolization, and the impediment that these devices can pose to future IVC thrombectomy.
*'''<span style="color:#ff0000">Preoperative angioembolization'''
*'''<span style="color:#ff0000">Preoperative angioembolization'''
**'''<span style="color:#ff0000">Can be considered to attempt to shrink the thrombus and facilitate surgery'''  
**'''<span style="color:#ff0000">Can be considered to attempt to shrink the thrombus and facilitate surgery'''