Advances in information technology, telecommunications, robotics and endoscopic equipment have found a place in medicine, especially in surgery. The introduction of new technology has allowed surgeons to operate and work through small incisions (cuts); before much larger ones were necessary and these often produced great pain and required a long convalescence.
Laparoscopy (sometimes called keyhole surgery) is a minimally invasive alternative to conventional open surgery, in which a small camera (called a laparoscope) is used to see inside the abdomen. The laparoscope transmits images of internal organs to a monitor which the surgeon uses to guide the surgical intervention. The laparoscope magnifies the image several times so internal organs can be seen more clearly.
How is a laparoscopy carried out?
Laparoscopic surgery is minimally invasive – it only requires 3 or 4 small incisions (0.5 – 1 cm long) instead of one of 15 to 20 cm in length. The instruments used in the operation are inserted through these incisions.
Conventional Open Surgery
What urological ailments can be treated via laparoscopic surgery?
Laparoscopic surgery can be used in the following procedures:
What are the benefits of laparoscopy?
Patients undergoing laparoscopic surgery have all the same benefits as with conventional open surgery, but with notably less pain after the operation, a shorter hospital stay, a quicker recovery and better aesthetic results. Patients can also return to their normal diet and daily activities much sooner.
What are the risks of laparoscopic surgery?
As in all surgical procedures, there is a risk of complications. The doctor will carry out a thorough assessment to indicate the appropriate procedure for each patient. However, in a small percentage of cases, it might be necessary to forgo laparoscopic surgery for a conventional open procedure – the reasons for this might be:
1. A serious complication during the operation
2. Where the operation is not progressing as foreseen by the surgeon.
Your surgeon will comment on the possible risks with you in detail before surgery.
Can all patients have laparoscopic surgery?
It should be noted that laparoscopic surgery is not appropriate for all patients. Each person’s circumstances need to be considered on an individual basis. Some factors that may impede or advise against laparoscopic surgery are: severe chronic obstructive pulmonary disease, previous surgery, and morbid obesity, amongst others.
DESCRIPTIONS OF SOME LAPAROSCOPIC PROCEDURES
LAPAROSCOPIC NEPHRECTOMY: This is a minimally-invasive surgical technique for the treatment of kidney diseases (i.e. cancer, obstruction or lithiasis).
Laparoscopic nephrectomy is a minimally-invasive procedure allowing a shorter hospital stay for the patient, a quicker recovery time and the same results when compared to conventional open surgery. Many patients have had this type of surgery in the last few years. The operation usually lasts 2 to 4 hours, and consists in making 3-4 incisions (1 cm long) in the abdomen. The kidney is taken out via a 5-10 cm long incision, depending on the size of the kidney.
This procedure has proven to be very safe; nevertheless, as in any operation, there are risks and possible complications. Safety and complication rates are similar to those for open surgery. Potential risks include: Bleeding: Blood loss is possible during the operation, and a transfusion may be necessary for 5% of patients.
Infection: All patients are given antibiotics intravenously before the operation to minimise the risk of infection.
Damage to other organs or tissue: Although highly unlikely, there is a remote possibility that injury to other organs such as the intestine, veins or arteries, spleen, liver, pancreas, pleura and gallbladder may need further intervention. Injury may also occur to nerves and posture-related muscles. Such injuries can also be caused by open surgery.
Resorting to open surgery: During the course of the laparoscopic operation, it may be necessary to resort to open surgery if there are complications, resulting in a longer convalescence or a larger incision.
What happens after the operation?
What happens after being discharged from hospital?
LAPAROSCOPIC RADICAL PROSTATECTOMY
This procedure is carried out through 5 small incisions in the abdomen, while open surgery requires a long incision along the middle of the lower abdomen.
During the laparoscopic radical prostatectomy, the prostate gland is separated from the bladder and the urethra, which are then later re-joined. The prostate is taken out through one of the incisions, which normally needs to be opened slightly more (3-6 cm) depending on the size of the prostate.
The Preoperative consultation
In the preoperative consultation the urologist will study your medical record, PSA values, the result of the prostate biopsy diagnosing the cancer; the urologist may also look at a bone scan, a computed axial tomography (CAT scan) of the abdomen and pelvis, and any other tests that might be useful for treatment. The urologist will then discuss with you the options available for treating the prostate cancer.
Laparoscopic radical prostatectomy is an established and accepted treatment for localised prostate cancer. The procedure involves the participation of a team of surgeons, anaesthetists, nurses and technicians specially trained and qualified in laparoscopic operations.
Laparoscopic radical prostatectomy is carried out along the principles of open surgery but without the surgeon’s hand going into the abdomen. The laparoscopic lens and camera show a high-quality image on the monitor, enlarging the prostate on-screen to show up all the details and adjacent structures thus allowing the surgeon more precision.
Once the prostate is separated from the bladder, rectum and urethra, it is placed in a small plastic bag and taken out of the body through one of the incisions made to carry out the operation. The bladder is “re-joined” to the urethra to restore the urinary tract using laparoscopic techniques within the body.
A catheter is fitted through the urinary tract (urethra) in order to be able to empty the bladder and allow the urethra-bladder connection to heal. A small drainage tube is also placed via one of the incisions.
Laparoscopic radical prostatectomy lasts some 2 to 4 hours, but can vary depending on the patient, prostate size, pelvis shape, the patient’s weight, or previous abdomen or pelvic surgery.
There is some blood loss (approximately less than 500ml), although transfusions are rarely needed. The stay in hospital is between 3 and 5 days. The patient will need a catheter to be able to pass urine for the first 10 to 21 days, and retrograde cystography (a radiological test) will be carried out before removing the catheter to ensure that the urethra-bladder join has healed correctly. The result of the prostate analysis will take around 6-10 days. PSA analyses will be made after one month and monthly for the 3 months following the operation.
Possible Risks and Complications
Laparoscopic radical prostatectomy has proven to be safe, however, as in any surgical operation there are some risks and possible complications:
Laparoscopic pyeloplasty is a very safe procedure using a minimally-invasive technique which means that the hospital stay is short, recovery is faster and the results are similar when compared to traditional open procedures.
This type of surgery is recommended to correct obstructions or narrowing of the ureter (the tube that drains urine from the kidney into the bladder) where it joins the kidney. This alteration, called pyeloureteral junction obstruction, can cause pain, lithiasis (stones), hypertension and deterioration of the kidney’s functioning.
The procedure is carried out through 3 or 4 small incisions in the abdomen and consists of trimming away the obstructed part and re-joining the renal pelvis to the ureter. A plastic tube (called a ureteral catheter) in the ureter serves as a support for the join made during the pyeloplasty. The tube is left in for 4 weeks and is generally taken out in the consulting room using a flexible cystoscope.
Laparoscopic ureterolithotomy is an effective procedure for extracting ureteral lithiases (stones) where other techniques, such as extracorporeal shock wave lithotripsy or ureteroscopy, have failed.
This technique requires only a short stay in hospital and allows a rapid recovery. The results are comparable to those obtained by the same procedure via open surgery.
The procedure is carried out through 3 or 4 small incisions in the abdomen and consists of locating the stone, opening the ureter, extracting the stone and then suturing the ureter. It is normally necessary to fit a catheter which can be placed either previously to or during the operation via endoscope or laparoscope.
As with pyeloplasty, the catheter can be withdrawn in the consulting room using a flexible cystoscope.
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