TECHNIQUE

Nephrotomy in Rabbits (Disease Investigation & Management - Treatment and Care)

Summary Information
Type of technique Health & Management / Disease Investigation & Management / Techniques:
Synonyms and Keywords --
Description This description is based on that given by Jenkins (2004) (B602.22.w22).
Preparation
  • Note: renal function should be checked thoroughly before this surgery is attempted. (B602.22.w22)
  • Anaesthetise the rabbit. See: Treatment and Care - Anaesthesia and Chemical Restrait
  • Shave from pubis to midthorax.
  • Place the rabbit in dorsal recumbency.
  • Prepare the rabbit for aseptic surgery.
Initial surgery
  • Make a midline incision sufficiently long for abdominal exploration. See: Laparotomy in Rabbits
  • Drape saline-moistened laparotomy pads along the incision.
  • Place a Balfour retractor to provide better visibility. 
    • A Lonestar Veterinary Retractor can be used to provide increased exposure to the abdomen. (B601.17.w17)
  • Check for additional lesions in the abdomen.
  • Gently remove the caecum, colon and small intestines from the abdomen to facilitate kidney exposure; wrap these in moistened gauze.
  • OR preferably retract the intestines to provide access. This is more difficult to achieve but gives a lower risk of post-operative adhesions than if the intestines are removed from the abdomen. (V.w122)
Nephrotomy
  • Dissect the kidney free of its peritoneal attachments.
  • Rotate the kidney medially to expose the renal pelvis and proximal ureter.
  • Using appropriate-size serrefines or vascular clamps to temporarily occlude the renal vasculature.
  • Divide the kidney along the sagittal plane.
  • Remove renal calculi.
  • Use saline to flush the renal pelvis and calyces to remove any remaining small calculi.
  • Pass a 3.5- to 5- French catheter through the ureter into the bladder, checking that the ureter is patent.
  • Press the halves of the kidney together and hold for several seconds so the cut surfaces stick together.
  • Suture the kidney capsule with simple interrupted sutures using 4-0 to 6-0 (1.5 - 0.7 metric) suture material.
    • Place a suture every 2 - 4 mm.
  • Remove the vascular clamps.
  • Check the kidney for bleeding.
  • If minor bleeding occurs, cover the incision site with absorbable gelatin sponges (Gelfoam, Pharmacia & Upjohn) to control this.
Closing the abdomen
  • Gently replace the small intestines, colon and caecum into the abdomen.
  • Close the abdomen in a routine manner. See: Laparotomy in Rabbits

(B602.22.w22)

Appropriate Use (?)
  • For removal of a calculus in the renal pelvis, if kidney function is thought to be adequate and only minimal damage has occurred to the renal parenchyma. (B602.18.w18)
  • NOTE: Pyelolithotomy in Rabbits is preferred. (B602.22.w22)
Notes
  • Renal function should be checked thoroughly before this surgery is attempted. (B602.22.w22)
Complications/ Limitations / Risk
  • Not appropriate when significant damage to the renal parenchyma and reduction in kidney function has occurred. (B602.22.w22)
  • Complications may occur including post-operative renal failure. (B602.22.w22)
  • There is a risk of post-surgical tissue adhesions, particularly if the intestines have been removed from the abdomen rather than retracted. (V.w122)
Equipment / Chemicals required and Suppliers
  • Anaesthetic supplies.

  • Routine surgical instruments.

  • Suitable retractor - Balfour retractor or Lone Star Retractor.

Expertise level / Ease of Use
  • This procedure should only be carried out by an individual with appropriate clinical training and practical experience.
Cost/ Availability

The costs of a surgical operation include those associated with: (J15.30.w1)

  • Pre-operative diagnostics (e.g. radiography, ultrasonography, blood tests)
  • Anaesthesia.
  • Perioperative medication (e.g. analgesics, antibiotics, fluids).
  • Surgical preparation (of the operating theatre and the patient, including staff time).
  • Consumables and equipment.
  • Time of the surgeon and assistant(s).
  • Post-operative hospitalisation.
Legal and Ethical Considerations In some countries there may be legislation restricting the use of this type of technique to licensed veterinarians. For example in the UK: "The Veterinary Surgeons Act 1966 (Section 19) provides, subject to a number of exceptions, that only registered members of the Royal College of Veterinary Surgeons may practice veterinary surgery." (See: LCofC1 - RCVS Guide to Professional Conduct 2000 - Treatment of Animals by Non-Veterinary Surgeons).
Author Debra Bourne MA VetMB PhD MRCVS (V.w5)
Referee Aidan Raftery MVB CertZooMed CBiol MIBiol MRCVS (V.w122)
References B601.17.w1, B602.22.w22, J15.30.w1, V.w122

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