Laparoscopic urological surgery

Overview

Urology is a surgical specialty that treats illnesses of the male and female urinary tracts, as well as the male reproductive systems. Although urology is officially a "surgical specialty," because of the vast range of clinical problems that urologists deal with, urologists must be competent in other fields such as internal medicine, pediatrics, and gynecology.

Laparoscope is a surgical technique in which surgeons utilize a tiny, illuminated video camera (laparoscope) to examine internal organs and other structures in the abdomen and pelvis in order to detect and treat disease or damage. Unlike open surgery, which necessitates big incisions, laparoscopy necessitates just minor cuts, resulting in less postoperative pain and a speedier recovery.

Laparoscopic surgery is used in urology for a variety of operations, including kidney surgery, bladder repair, prostate removal, removing big kidney or ureter stones, ureteropelvic junction blockage, varicocele repair, undescended testes, adrenal cancer, and others.

What is Laparoscopic Urological Surgery?

Laparoscopic urological surgery, also known as endourology, is a subspecialty of urology that uses minimally invasive surgical procedures to view into the urinary system and perform surgery. Small endoscopes and instruments are used to remove or fracture kidney stones through locations such as the urethra, bladder, and ureter. In addition to removing kidney stones, surgeons can investigate the etiology of the stones and assist to prevent their formation. The majority of endoscopic treatments are performed as outpatient procedures.

The majority of treatments are outpatient, which means you can avoid a hospital stay. In rare situations of complicated stone illness, your surgeon may recommend percutaneous stone removal. The majority of patients remain overnight following this treatment. You are less likely to scar or acquire an infection since these treatments entail no or extremely minor incisions. You will also recover faster than with open surgery.

What are the indications of Laparoscopic Urological Surgery?

Small kidney stones can be located and removed using endourology. Stones can be extracted or shattered using small devices put into the urethra, bladder, ureter, and kidney. Aside from therapy, doctors can assist in determining what is causing the kidney stones and identifying measures to prevent further stones from developing. Thin, flexible devices such as lasers, graspers, micro stone retrieval baskets, specific scalpels, and cautery can be utilized to do surgery with no incisions. Almost all endoscopic treatments may be performed as an outpatient procedure.

Endourology operations are used to treat a variety of medical disorders, including:

• Urethral or ureteral obstructions
• Ureteral tumors and stones
• Prostate-blocking tissue

Are you a good candidate for Laparoscopic Urological Surgery?

You must consult with and be examined by an endourologist or laparoscopist. The doctor will consider your individual medical history as well as the nature of your ailment.

Urology is a continually evolving speciality. Many urologic surgeries that were formerly conducted by open surgery can now be performed using the Many urologic procedures that were formerly performed by open surgery can now be performed using a cystoscope, ureteroscope, or laparoscope. Much of this progress has been made possible by advances in technology. It will become more vital for urologists to be able to use these procedures with ability and experience.

What are the types of Laparoscopic Urological Surgery?

Endourology differs from traditional urology in that all treatments are performed internally, with no large incisions. Endourology is sometimes known as laparoscopic surgery or minimally invasive urologic surgery. The different types include the following:

• Urethroscopy – This is done if the surgeon has to examine the urethra or bladder thoroughly and obtain tissue samples from the lining of either location to clarify the condition. The treatment is used to treat urethral strictures and obstructions.
• Cystoscopy – A cystoscope, a thin camera, was used to view within the bladder. It is introduced into the urethra and into the bladder to let a doctor to view inside. To treat bladder disorders, small tools can be passed via the cystoscope.
• Ureteroscopy – It allows the urologist to see the urinary system clearly, remove or break up stones, and remove suspicious-looking tissue. This therapy is occasionally used in conjunction with shock wave lithotripsy, a treatment for breaking up kidney stones. Ureteroscopy is used to treat ureteral blockages and tumors.
• Nephroscopy – This is a non-surgical method of inspecting the interior of the kidneys. It is used to treat kidney stones, tumors of the kidney lining, and other upper urinary tract diseases. The narrow tube component is introduced into the skin with the help of a tiny tool known as a nephroscope.

Laparoscopic urologic surgery is used to treat a wide spectrum of benign and malignant urologic disorders. Laparoscopic procedures most typically used include pyeloplasty, nephrectomy, partial nephrectomy, radical prostatectomy, and radical cystectomy.

What is Laparoscopic pyeloplasty?

Laparoscopic pyeloplasty is a minimally invasive method for performing reconstructive surgery on a constriction or scarring where the ureter (the tube that empties urine from the kidney to the bladder) joins to the kidney.

This procedure is done to repair a blockage or narrowing of the ureter where it exits the kidney. This condition is known as a ureteropelvic junction (UPJ) blockage, and it causes poor and slow urine outflow from the kidney. UPJ blockage can result in stomach and flank discomfort, stones, infection, high blood pressure, and kidney function decline.

Procedure:

General anesthesia is used for laparoscopic pyeloplasty. The surgery usually lasts three to four hours. Three tiny (1 cm) incisions are made in the belly to accomplish the procedure. Through these keyhole incisions, a telescope and small instruments are introduced into the abdomen, allowing the surgeon to fix the blockage/narrowing without having to enter his or her hands into the abdomen.

At the completion of the treatment, a short plastic tube (called a ureteral stent) is left within the ureter to bridge the pyeloplasty repair and assist drain the kidney. This stent will be left in place for four weeks before being removed at the doctor's office. A tiny drain will be left leaving your flank to drain any fluid surrounding the kidney and to heal the pyeloplasty.

Possible complications:

Although this surgery has shown to be highly safe, there are risks and potential problems, as with any surgical operation. When compared to open surgery, the safety and complication rates are comparable. Potential hazards include:

• Bleeding: Typically, blood loss during this treatment is minimal (less than 100 cc), and a blood transfusion is rarely necessary.
• Infection: To reduce the possibility of infection following surgery, all patients are given broad-spectrum intravenous antibiotics prior to surgery. If you have any indications or symptoms of infection following surgery (fever, discharge from your incision, urine frequency, discomfort, pain, or anything else that causes you worry), you should call your doctor.
• Hernia: Hernias at incision sites are uncommon since all keyhole incisions are properly closed at the end of your procedure.
• Tissue/organ injury: Although uncommon, harm to surrounding tissue and organs such as the colon, vascular structures, spleen, liver, pancreas, and gallbladder may necessitate further surgery. Positioning-related nerve or muscle injury is possible.
• Conversion to open surgery: If considerable difficulties are encountered during the laparoscopic surgery, the treatment may be converted to a regular open operation. This might lead to a bigger conventional open incision and a longer recovery period.
• Failure to correct UPJ obstruction: Approximately 3% of individuals who have this procedure will have a chronic obstruction owing to recurring scarring. If this happens, subsequent surgery may be required.

What is Laparoscopic nephrectomy?

A laparoscopic nephrectomy is a procedure that removes one of the two kidneys that are located in the rear of the abdomen. Urine is produced by the kidneys by filtering waste items and excess fluid from the circulation. Urine flows from the kidneys down the ureters into the bladder, where it is held until the individual needs to use the restroom.

A complete kidney is removed during a laparoscopic nephrectomy using keyhole incisions in the flank, the side of the body between the ribs and the hip. A nephrectomy is often performed for one of two reasons: kidney cancer or a non-functioning kidney.

Procedure:

A Long, thin tools are passed into up to five tiny, 1cm-long incisions in the flank. The abdomen is initially inflated with carbon dioxide, which separates the tissues and allows for visibility throughout the procedure. The urologist is then shown a detailed image of the abdomen through a camera. The other incisions allow cutting and suturing equipment to pass through, allowing the blood supply to the kidney to be separated and closed off, and the kidney to be removed with or without its surrounding tissues. After that, a wound drain is installed to remove any wound oozing. This is typically stitched in place and remains in place for 1 to 2 days.

When the procedure is completed, the carbon dioxide air is expelled from the abdomen and the wounds are repaired with dissolving stitches. Small plasters are then applied to the affected regions. To monitor the urine production from the remaining kidney, a catheter (a drainage tube that drains urine from the bladder) is also implanted. The catheter is normally left in place for 1 to 2 days, or until you are able to move around. Laparoscopic Nephrectomy takes between 2 - 4 hours to complete and requires a 1 - 2-night hospital stay.

Possible complications:

There is a possibility of infection and blood loss with any procedure. The kidneys have a significant blood supply, and operation always involves some bleeding. Antibiotics are frequently used during surgery to avoid infection. A blood transfusion may be required to compensate for blood loss after surgery in a limited percentage of patients.

There is always the possibility that the surgeon may need to do open surgery, which requires a single, bigger incision in the flank. This occurs seldom and might be caused by equipment failure, significant bleeding, or other complications encountered during the surgery.

What is laparoscopic radical prostatectomy?

Laparoscopic radical prostatectomy is a minimally invasive surgical treatment performed to remove a malignant prostate from a patient. Laparoscopic surgery differs from typical open surgery in that it is performed through five tiny incisions rather than one big one. This results in less abdominal trauma, better aesthetic outcomes, and a shorter recovery time.

Procedure:

General anesthesia is used for the laparoscopic radical prostatectomy. This will sedate you for the length of the procedure. The surgeon will then make tiny incisions in the skin to implant surgical equipment and a camera. The prostate gland is then separated from the surrounding tissue by the surgeon. The seminal vesicles, which are two little fluid-filled sacs located close to your prostate, are also removed. The urethra will be reattached to a section of the bladder called the bladder neck by the surgeon. At this stage, your surgeon may additionally remove the lymph nodes for biopsy to screen for malignancy (depending on the patient).

Although this operation takes around 3 hours to complete, patients often feel substantially better and use significantly less pain medication in the early postoperative period. Unlike open surgery, when the catheter is left in place for two to three weeks, most laparoscopic prostatectomy patients have their Foley catheters removed on the third day.

Possible complications:

According to medical studies, the symptoms of incontinence and impotence are comparable for both minimally invasive and standard surgery. Men often regain normal urine function after three months.

Because this approach spares the nerves, a man's ability to achieve an erection after surgery should be equivalent to that of regular surgery. Recent research has found no difference between laparoscopic and open procedure, often known as open radical prostatectomy (ORP). 

What is laparoscopic radical cystectomy?

A cystectomy is a surgical technique used to remove the bladder, most commonly owing to malignancy. The bladder is a pouch in the pelvic region. It stores urine produced by the kidneys until it is full and must be emptied. A radical cystectomy is the surgical removal of the whole bladder. In males, this usually entails removing the prostate and seminal vesicles. In most cases, a radical cystectomy involves the removal of the uterus, ovaries, fallopian tubes, and a portion of the vagina.

After removing your bladder, your surgeon must devise a new route for pee to be stored and expelled from your body. This is known as urine diversion. Your surgeon will go over the urinary diversion options that are available to you.

For chosen patients with localized muscle-invasive bladder cancer, laparoscopic radical cystectomy may become an appealing therapy option. Patients with small-volume bladder cancer with no extravesical involvement or pelvic lymphadenopathy on abdominal computed tomography are now eligible for the surgery.

Procedure:

You will be given a general anesthesia with muscular relaxation prior to the procedure. A laparoscopic radical cystectomy usually takes 3 to 5 hours. Your surgeon will remove your bladder and prostate through numerous tiny incisions during laparoscopic radical cystectomy (this is less traumatic than an open surgery and will help you to heal better). Your surgeon will have many choices after removing the bladder to construct a new bladder (neobladder) from existing tissue. Because each patient is unique, it is critical that you question your doctor about the specifics of the procedure.

Possible complications:

Cystectomy is a complex surgery. It involves the manipulation of many internal organs in your abdomen. Because of this, cystectomy carries with it certain risks, these risks are much lower with laparoscopic than open procedure.

After a laparoscopic radical cystectomy, there are early and late postoperative problems, as well as surgical reoperations. Complications of the abdominal wall are prevalent and serve as the primary reason for reoperation during long-term follow-up.

Overall problems, high-grade complications, and fatality rates were 53%, 17%, and 1.4% at 90 days, respectively. The most prevalent problems were gastrointestinal (25%), infectious (22%), and abdominal wall-related (9%). At 5 years, the reoperation rate was 25%. The primary reasons for reoperation were gastrointestinal issues in the early postoperative period and abdominal wall-related difficulties in the late postoperative period.

What happens after Laparoscopic Urological Surgery?

Patients may experience fatigue, soreness, and bruising around the incision in the first several days. Those who have undergone general anesthesia, which necessitates the insertion of a tube down the throat, may experience a painful or uncomfortable throat. Everything should clean up on its own. Patients may also notice bloating or an increased desire to pee since gas is used to expand the abdomen.

Patients may normally resume most normal activities the next day, but should avoid vigorous exercise or activity for at least a week. Furthermore, a little amount of gas might occasionally seep into the skin, causing a crackling sound surrounding the incision. This is not a significant problem and should go away in a few days.

The reduced post-operative discomfort associated with laparoscopic urologic surgery is widely documented. It is one of the most crucial components of surgery because people are more anxious about post-operative care than they are about the operation itself. As a result, laparoscopic urologic surgery is ideal for patients. It eliminates the need for epidural catheters and controlled analgesia.

The following day, oral feeding is initiated. Prior to surgery, a single dose of antibiotic prophylaxis is given, which is not repeated afterwards. Routine lab tests are conducted on the same evening and the next morning, allowing the doctor to monitor the patient if necessary.

What are the Advantages of Laparoscopic Urological Surgery?

The following are the most major advantages of laparoscopic urological surgery:

• Reduced Bleeding: Which lowers the likelihood of requiring a blood transfusion.
• Smaller Incision: This not only minimizes pain but also shortens healing time, resulting in fewer scarring and surgical marks after surgery.
• Less Pain: Patients suffer less pain since the operation is minimally invasive. As a result, patients will need less postoperative analgesic drugs.
• Shorter Hospital Stay: Although the operation takes somewhat longer, the hospital stay is significantly shorter in this procedure. The patient is often released the same day.
• Reduced Risk of Catching Infections: The operation reduces the exposure of internal organs to external pollutants, lowering the risk of infection.

What are the disadvantages of Laparoscopic Urological Surgery?

Laparoscopic urological surgery is quickly becoming the most popular alternative in modern surgery, yet several constraints prevent its widespread usage for certain large operations and difficult procedures. In any case, the popularity of laparoscopic surgery was based on its less intrusive nature, smaller incisions, shorter hospital stay, and reduced rate of problems as compared to some older surgical procedures.

Although it may appear that laparoscopic surgery has no drawbacks, this is not the case. Some unfavorable characteristics do exist in its repertoire and so demand time and effort to relieve. These are some of the key difficulties that hinder it from being adapted to a broader range of procedures that do not currently consider adapting laparoscopy.

• Expensive and technological requirements
• Because not all surgical theatres can house a laparoscopic unit, not all institutes will be able to offer the facility for every procedure. As a result, it may take some time for this technology to become cost viable for less wealthy institutions to make available to a larger patient population.

Conclusion

Laparoscopy was added to the urology toolbox only around ten years ago. The beginning was gradual, with just pelvic lymphadenectomy, nephrectomy, and varicocelectomy as indications. However, enthusiasm quickly grew, and almost every urological operation was performed via laparoscopy.

This extreme enthusiasm has to be followed by disappointment for a variety of reasons. To begin with, laparoscopy proved to be more difficult than many anticipated. Many surgeons were never able to overcome their learning curve due to the limited number of procedures, and the early literature reflects this difficulty. Unlike in general surgery, where cholecystectomy became into a pacemaker procedure, forcing everyone to go with laparoscopy, urology spent a long time looking for appropriate and frequent reasons for this new method.

The pendulum has swung back to the other side in recent years. Adrenalectomy was one of the first cases where laparoscopy outperformed open surgery in every way. Several more good reasons followed, including undescended testes, nephrectomy, and pyeloplasty. However, the current advance is attributable to the success of laparoscopy in the field of oncologic surgery.

Laparoscopic radical nephrectomy has demonstrated both surgical and oncologic effectiveness. However, the major focus is now on radical prostatectomy, which is currently the most often-done procedure in urology. This operation has recently been developed into a standardized technique, but only time will tell how effective it is.