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Laparoscopic Urology

Urology focuses on the diseases of male and female urinary tract (kidneys, ureters, adrenal glands, bladder and urethra) and male reproductive organs (testes, penis, scrotum, epididymis, vas deferens, seminal vesicles and prostate). Both urinary and reproductive tracts are closely linked to each other and disorders of one can affect the other. Urology problems can be managed with both non surgical treatment for medical conditions like urinary tract infections and benign prostatic hyperplasia and surgical treatment for conditions like bladder or prostate cancer, kidney stones, congenital abnormalities, traumatic injury etc. There are many advance techniques for treating urological problems such as minimally invasive robotic and laparoscopic surgery, laser assisted surgeries or scope guided surgeries performed by highly trained and experienced urologists. Laparoscopic or keyhole surgery has recently developed in the field of urologic treatment with advanced techniques and computer technologies. This is minimal invasive technique that is used to correct many urological problems including benign and malignant tumors, many other urologic organs like kidney, adrenal gland, ureter, bladder, prostate, and lymph nodes. it is much preferred treatment option that provides patients with a safer, quicker recovery, reduced pain, minimal blood loss, minimum hospital stay and improved cosmetic result as compared to the traditional open surgical method. In this surgical procedure, surgeon will insert a laparoscope which is long thin flexible tube with a camera attached to its front through a small incision made to access ureter. This laparoscope sends internal images of the abdomen to a video monitor through which surgeon rectify the urinal problems like kidney stone, tumor in kidney, ureteral block or obstruction etc. This procedure also helps in avoiding a larger incision or surgical opening as required in the conventional surgical method.

Laparoscopic urologic procedures can be done in two ways: Transperitoneally Approach or Retroperitoneally Approach.

• Transperitoneal approach– is commonly used for performing laparoscope due to its familiarity, a larger working space and natural orientation to natural landmarks but still it requires mobilization and reflection of the colon. The anterior abdominal wall musculature is traversed by anterior ports and the line of Toldt is incised to reach the kidneys.

• Retroperitoneal approach - in this, laparoscopic access is made via the superior or inferior lumbar triangle. This approach is more beneficial than transperitoneal because of safe port placement, visceral handling with less risk of injury, easy and faster access to the renal pedicle and renal artery control. Retroperitoneal laparoscopy may be technically more challenging due to the smaller working space and port proximity.

Hand assisted laparoscopy minimizes intra-operative complications and control problematic bleeding more easily. This surgical technique enables experienced laparoscopist to deal with more complex procedures with more confidence and ease than in conventional laparoscopy alone.

Laparoscopic simple nephrectomy - is the most common urologic laparoscopic procedure for treating benign non-functioning kidneys. Laparoscopic simple nephrectomy is a minimally invasive technique for complete removal of diseased kidney and large tumor. It is much preferred treatment option that provides patients with a safer, quicker recovery, reduced pain, minimum blood loss, minimum hospital stay and improved cosmetic result as compared to the traditional open surgical method.

Donor nephrectomy – is surgery to remove a healthy kidney from a live donor for transplant into a patient with failed kidney functions. A person can donate one kidney while the other remaining one is able to perform the essential functions. End stage renal disease patient is required to remove waste from their bloodstream through dialysis or a kidney transplant to stay alive.

Laparoscopic Pyeloplasty - Pyeloplasty is a surgical procedure to correct a problem of the renal pelvis in the kidney where the urine is collected, usually to remove blockage or obstruction that can cause long term serious complications including failure of kidney functions, urinary infections and formation of kidney stones. This abnormality is known as an ureteropelvic junction obstruction. Laparoscopic pyeloplasty is less invasive, safe and effective procedure to perform reconstructive surgery of a narrowing or scarring in the ureter attached to the kidney. Laparoscopic pyeloplasty has significant results and outcomes identical to that of the conventional open surgery procedure but with reduced post surgery pain, shorter hospital stay, faster recovery, less scarring.

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