The term urology refers to the genitourinary tract (body organs that deal with urine formation, evacuation and reproduction) in both males and females. In females this field is majorly covered by gynecologists and obstetricians and in males there are specialist urologists who deal with these problems.
Earlier due to lack of technology and sophisticated instruments, most of the surgeries required big incisions that involved cutting of large muscles, lot of blood loss, longer recovery period and thus a longer hospital stay. Now with the advent of new technology, minimally invasive surgical procedures have become more prevalent and since they involve a shorter recovery period and minimum complications, they are preferred by patients and doctors.
Minimally invasive surgery is also known as keyhole surgery and is carried out with the help of a special instrument known as laparoscope. This instrument is a fiber optic tube which has light and camera at its tip. This camera when inserted inside the body cavity shows the actual condition of the tissues inside and these pictures are projected on the computer screen. The surgeon is able to see the actual picture and decide his action plan. Micro sized surgical instruments are inserted through small holes made in the abdomen and manipulated by the surgeons to complete the procedure with minimum damage to surrounding tissues. The area is expanded by introducing an inert gas which gives the surgeons better visibility. Since the muscles cutting is less and blood loss is minimum, the postoperative complications and recovery time is less. The surgery must be carried out by specialist urologists who are trained and experienced in laparoscopic surgeries. Also these surgeries require longer time to be carried out.
Advantages of Laparoscopic Surgery
- Instead of one single large incision of 10-15 cm, 3-4 small keyhole incisions of 3-5 mm are made.
- Healing time is less so recovery is faster
- Lesser scar tissue and less blood loss.
- Minimum injury to surrounding tissues
Types of Procedures for Laparoscopic Urology
Many types of procedures that deal with conditions of kidneys, bladder, urethra, vagina and testes etc., are included in laparoscopic urology.
Laparoscopic removal of kidney cancer: Using the micro instruments the diseased part of the kidney or the entire kidney is crushed and removed through the 3-4 tiny holes of 5mm to 10mm size. In case of kidney failure also this procedure can be used to remove damaged kidney.
Laparoscopic removal of bladder cancer: Keyhole incisions are made in the lower part of abdomen through which instruments are inserted to carry out partial removal of bladder wall if cancer is localized or total removal of bladder along with lymph nodes if the cancer has spread. A new artificial bladder is constructed to allow the patient to store urine.
Laparoscopic removal of prostate cancer: Recently advanced laparoscopic surgery with the help of a robot called the da Vinci system is fast getting popularity among surgeons. The robot carries out the entire surgery through keyhole incision made in the lower part of abdomen. The small incisions allow full or partial removal of the prostate gland with minimal damage to bladder or urethra. The surgeon controls the robot from a remote distance.
Laparoscopic Hernia repair: Hernia is a weak point in the abdominal wall through which abdominal contents can spill out while coughing, sneezing, picking up heavy weights or straining during defecation. 2-4 keyholes are made near the inguinal area in case of inguinal hernia repair and a prolene sheet is placed to cover the defect. Bilateral inguinal hernia repair can also be carried out using laparoscopic surgery.
Laparoscopic repair of Pelvic - ureteric junction: The kidneys produce urine that is collected in the renal pelvis from where it passes through the long tubes called ureter to enter the bladder. At times there is an obstruction at the point where the renal pelvis becomes continuous with the ureters. There is narrowing at this point. The surgery requires removing of this narrowed junction, trimming of the renal pelvis and reattachment of the ureters to the renal pelvis. Traditionally this required a 10 cm long incision in the abdomen, but a laparoscopic surgery involves making of only 3-4 keyholes around the umbilicus.
Laparoscopic removal of stones in the ureter, kidney and bladder: 3-4 keyhole incisions are made through which the laparoscope is introduced to visualize the size and location of the stones. Special probes are inserted through the instrument which powder the stones and suck them out or direct them to the bladder from where they can be flushed out.
Laparoscopic treatment of undescended Testes: Generally the testes descend from the abdomen into the scrotum just before birth in male babies. However sometimes this doesn’t take place and they need to be put in their position through surgery. This surgery requires a lot of precision which can only be attained through magnification by a laparoscopic camera as the surgery needs to be carried out at one year when the body parts of an infant are really small.
Laparoscopic repair of Vesico - vaginal repair: Usually the vaginal wall and the bladder wall are distinct but at times due to injury, disease or prolonged labor an abnormal connection forms between them. This causes urinary incontinence. Through 4 keyholes during laparoscopic surgery, the organ walls are repaired and a layer of fat obtained from the abdomen is placed between the walls. Repair by traditional surgery would require a bigger incision and more damage to surrounding structures during approach as both bladder and uterus are placed deeply.
Laparoscopic Varicocoelectomy: Usually the testis is placed in the scrotum, and is at a lower temperature than the rest of the body so as to allow normal sperm production. But sometimes the veins carrying blood from testis to the heart get blocked, dilated and engorged. The blood collects here making the testes warm. This can affect sperm production. Through laparoscopic surgery, 3 - 4 keyholes are made and the blood supply to this vein is stopped.
All these surgeries require a shorter hospital stay of around 3-4 days and a faster recovery period of 15 days as opposed to traditional surgery where the hospital stay can be as long as 2 weeks and the patient slowly gets back to normal activities of daily living by 6 weeks.
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