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Related Concept Videos

Kidney Transplant II: Surgical Procedure01:26

Kidney Transplant II: Surgical Procedure

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Preoperative ManagementThe primary goals of preoperative management in kidney transplantation are to optimize the patient’s metabolic state and prepare them for surgery through diet adjustments, necessary dialysis, and tailored medical treatment. This phase also involves comprehensive infection screening and patient education about the surgical procedure and postoperative care to improve outcomes and adherence.Medical ManagementA comprehensive evaluation is required for both the living...
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Kidney Transplant III: Nursing Management01:16

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Postoperative Nursing Management for Kidney Transplant PatientsPostoperative nursing management care includes monitoring the surgical site, encouraging early movement, and promoting lung health through breathing exercises. Nurses also administer prescribed medications like H2-blockers, such as famotidine, or proton pump inhibitors, like omeprazole, to help prevent gastrointestinal ulcers and bleeding. Fungal infections in the mouth and bladder can result from immunosuppressive and antibiotic...
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Kidney Transplant I: Introduction01:28

Kidney Transplant I: Introduction

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A kidney transplant is a surgical approach that involves replacing a non-functioning kidney with a healthy one from a donor. This procedure is often a treatment option for end-stage renal disease (ESRD) patients. The method requires careful recipient selection, including evaluating various medical and psychosocial factors. These criteria vary between transplant centers but generally include assessments of the patient's overall health, adherence to medical recommendations, and lifestyle...
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Acute Kidney Injury II: Pathophysiology01:29

Acute Kidney Injury II: Pathophysiology

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Acute kidney injury (AKI) causes are categorized into three primary categories based on the location of the injury: prerenal, intrarenal (or intrinsic), and postrenal causes. This classification guides clinical management and illustrates how different pathways can impair kidney function.Etiology and Pathophysiology of Acute Kidney Injury1. Prerenal causesEtiology: Prerenal Acute Kidney Injury, the most common type, occurs when reduced blood flow to the kidneys decreases filtration capacity...
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Acute Pyelonephritis I: Introduction01:27

Acute Pyelonephritis I: Introduction

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Pyelonephritis is a bacterial infection that primarily affects the renal parenchyma and collecting system, including the renal pelvis, tubules, and interstitial tissue of one or both kidneys. It can be classified as either acute—a sudden, severe infection—or chronic, which refers to long-term or recurrent kidney infections.The primary cause of acute pyelonephritis (APN) is bacterial infection, with Escherichia coli accounting for approximately 70-80% of cases. Other bacteria, such...
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Acute Kidney Injury IV: Diagnostic Studies and Prevention01:30

Acute Kidney Injury IV: Diagnostic Studies and Prevention

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Accurate diagnosis and effective prevention are critical in managing Acute Kidney Injury (AKI), which is linked to high mortality rates ranging from 10% to 80%. Timely recognition of at-risk patients and careful monitoring can significantly reduce the likelihood of kidney damage.Diagnostic Assessments:The diagnostic process starts with a comprehensive medical history to identify prerenal, intrarenal, and postrenal causes.Prerenal causes, such as dehydration, hypotension, or blood loss, should...
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Related Experiment Video

Updated: Sep 17, 2025

5/6 Nephrectomy Using Sharp Bipolectomy Via Midline Laparotomy in Rats
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Risk Factors Associated With Unplanned Conversion to Open in Radical and Partial Nephrectomy.

Benjamin A Fink1, Young Son2, Kimberly C Toumazos3

  • 1Department of Urology, Jefferson Health, Stratford, USA.

Cureus
|July 2, 2025
PubMed
Summary

Minimally invasive kidney surgery may require unplanned conversion to open surgery. Higher tumor stage, ASA classification, and abnormal lab values predict these conversions and worse patient outcomes.

Keywords:
minimally invasive surgerypartial nephrectomyradical nephrectomyrenal cell carcinomaunplanned conversion to open

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Area of Science:

  • Urology
  • Surgical Oncology
  • Health Services Research

Background:

  • Minimally invasive surgery (MIS) is standard for kidney cancer, offering faster recovery.
  • Unplanned conversion to open surgery increases complication and readmission risks.
  • Predictors for conversion from MIS to open nephrectomy are not well understood.

Purpose of the Study:

  • Identify predictors for unplanned conversion to open surgery in nephrectomy patients.
  • Analyze outcomes associated with unplanned conversions.
  • Improve patient selection for open surgery when necessary.

Main Methods:

  • Retrospective analysis of 4,862 nephrectomy patients from the 2019-2020 ACS NSQIP database.
  • Comparison between planned MIS (n=4,756) and unplanned conversion to open (UCO) (n=106) groups.
  • Statistical analysis using Wilcoxon signed-rank and Fisher's exact tests (P<0.05).

Main Results:

  • The unplanned conversion rate was 2.2%.
  • Higher tumor stage (T3/T4) and American Society of Anesthesiologists (ASA) class 3/4 were linked to unplanned conversions.
  • Worse outcomes observed in the UCO group included longer operative times, increased blood transfusions, and longer hospital stays.

Conclusions:

  • Predictive factors for unplanned conversion include advanced tumor stage, higher ASA classification, impaired kidney function, and elevated PT/INR.
  • Unplanned conversions are associated with increased postoperative complications and prolonged hospitalizations.
  • Identifying these risk factors can optimize surgical planning and patient selection for nephrectomy.