Uro-laparoscopic surgery

What is uro-laparoscopic surgery ?
Laparoscopic surgery is what is commonly known as key hole surgery. This is done by special instruments and a video – camera system, where the operation is done by seeing it on a TV screen.
This gives an enlarged view of structures and the operation can be done more cleanly. The surgeon’s hands remain outside, a long cut it not required for accommodating the surgeon’s hands.
Since the cut is small, the pain is minimised to a great extent. The cut sometimes is enlarged only for removal of organ or the part of it, which can be done by few centimetre incision. (4–8 cms only.) The cut for any open or conventional operation for kidney is about 15 to 25 cms to over a foot in obese person. When repair of some defects is done, i.e. organ is not removed, the largest cut is not more than 1.5 cm.

What are the advantages of Laparoscopic surgery?
All the advantages are related to much smaller cut on the body and clear and enlarged vision under which the surgery is performed.

The biggest advantage is :-
NO UGLY SCARS and MUCH LESS PAIN
This means :-
- Less amount of pain killers.
- Early start of activity.
- Early discharge.
- Early recovery and early return to the work.
- Much less chances of wound infection and hernia.
- Better body image
- Less blood loss, since the vision of operative area is better.

Is laparoscopic surgery more costly than conventional surgery?
NO.
The increased cost of equipments is compensated by
- saving on duration of hospital stay
- need for less medicines

What kidney operation can be done by laparoscopy?
For most kidney operations, laparoscopy has already become the operation of choice. These are –
- Removal of damaged kidney due to any cause, (Nephrectomy)
- Removal of kidney due to cancer
- Removal of part of kidney due to small cancer
- Correction of obstruction leading to swelling of kidney – Pyeloplasty for UPJ obstruction.
- Chyluria,
- Large Cysts,
- Special situations for stone like large ureteric stone.

In 21st century, the question to be asked is not “Why laparoscopic surgery” but “Why open surgery”

What other urologic operations can be done by laparoscopy?
- Operation on adrenal gland
- Operation for some early cases of Cancer Bladder and Cancer Prostate.
- Varicocoele operation in cases of male infertility.
- Reconstructive surgery on ureter or bladder.

Is laparoscopic surgery less complete that conventional or open surgery?
It is a myth that disease /organ is left behind if done by laparoscopy.
In fact in most situations, the surgeon can do a better job due to improved and enlarged vision by the help of camera and screen. There is less bleeding so the operative area is cleaner. These factors add together for a more complete job.

Why one should ask for laparoscopic surgery ?
Fortunately, today, most of the kidney operations can be done by this method. Laparoscopic surgery has replaced open surgery in many situations due to less morbidity i.e. the patients feel less sick for lesser duration.
This makes the experience of undergoing an operation less painful and more convenient. One can easily understand this by seeing the pictures of real patients who underwent laparoscopic operations. One can also interact with these patient ask their experiences.

Compiled by:
Dr. Ajay Sharma
Sr. Consultant, Laparoscopic Urologist