A team of urologists at the Nizam’s Institute of Medical Sciences (NIMS) here operated on a 22-year-old youth on Tuesday after it found a stone formed around a stent in his abnormally-located left kidney. The stent had been placed there during a kidney procedure performed three years ago, but was not removed thereafter.
Rahul Devraj, professor in the department of Urology And Renal Transplantation at NIMS, said that the patient is recovering well. The surgery costs around ₹5 lakh in corporate hospitals, but was performed free of cost at NIMS, under Aarogyasri Health Scheme.
The youth consulted doctors at the institute around two weeks ago with complaints of abdominal pain, fever, and pain while passing urine.
Kidneys are located in the abdominal cavity, below the diaphragm. While the patient’s right kidney is in the abdomen, his left kidney is located above the diaphragm, in the thoracic cavity. “It is by the side of his left lung and heart, making it a very rare and a challenging case. A stent was placed in his kidney to remove left ureteric stone three years ago. The stent was supposed to be removed two to three weeks after the surgery. However, it was forgotten. A stone formed around it,” said Dr Rahul, who performed the surgery along with Ch. Ram Reddy, head of Urology and Renal Transplantation department.
Since it was a peculiar case, doctors took about a week to decide how to operate on the patient. Two devices with micro cameras were used to monitor the surgery. A video-assisted thoracoscopic surgery guided PCNL (percutaneous nephrolithotomy) was used. This was inserted using a key hole. Another key hole was made to insert an endoscope, which too has a small camera. This helped navigate through the chest cavity to the left kidney, avoiding injury to the heart or lung.
“During surgery, the patient was placed on single lung ventilation, in which the left lung was collapsed to ensure safety to the left lung as well as the heart. A key hole endoscopic procedure was performed on his left kidney in the chest to remove the stone along with the retained stent under video thoracoscopic guidance,” said Dr Rahul.
The surgery was successful. The patient would be discharged in a few days.
