Renal Cell Carcinoma for Laparoscopic Nephrectomy

Renal cell carcinoma is the most common urological malignancy which can be managed surgically in the advance stage to improve the quality of life. Preoperatively recent imaging studies are recommended because of the nature of renal cell carcinoma to extend through venous invasion, a 2D ECHO and lower limb Doppler will be done prophylactically in high-risk patients. General anesthesia with endotracheal intubation and epidural analgesia is the preferred anesthesia technique. The surgery is done under the vicinity of major vessels and intraoperatively bleeding is expected so good intravenous access should be taken and invasive monitoring should be done in selected high-risk patients. Team must be cautious during the positioning of the patient to avoid any nerve and organ injury. Preoperative hypovolemic state should be avoided and target urine output kept above 1 mL/kg body weight. Laparoscopic radical nephrectomy patients may complain mild to moderate pain in the immediate postoperative period, they also complain of shoulder pain which is due to irritation of peritoneum, diaphragm, and neuroprexia, which can be managed successfully with intraoperative and postoperative intravenous opioids and paracetamol. Neuraxial or regional analgesia technique provide good perioperative pain relief, decrease the requirement of opioids, and the patient can mobilize early.