Writen by Konstantinos Efstathiou, Scientific Head of the Urology Department of ANASSA Clinic
Laparoscopic surgery is the most modern method for treating diseases of the Urinary tract.
It belongs to the so-called minimally invasive methods and is the method of choice in almost the entire range of Urological operations.
Laparoscopic surgery or Minimally invasive or Video Surgery or Surgery through small holes (keyholes), as it is otherwise known – is an innovative surgical method, with which the operation is performed minimally traumatic and minimally invasive through small holes that are opened in the abdomen and with the help of the overview of the surgical field with a special, high-definition video camera.
The word “laparoscopy” comes from the words “lapara” meaning belly and “scopo” meaning to see. In classical open surgery, the procedure is performed through an incision in the abdominal wall to allow for a direct overview and tactile contact of the patient’s organs. In contrast to laparoscopic urological surgery, the operation is performed through small skin incisions of 5-10 mm in the abdomen. Through these, special instruments and a high-definition digital optical camera are inserted into the surgical field to perform an operation.
The special laparoscopic camera transmits the image of the surgical field enlarged 10-15 times to a digital screen. This allows the entire surgical and anaesthesia team to see the operation live and, when necessary, in 3D. It goes without saying that the whole procedure is digitally recorded.
Let’s look at some interesting historical data. The first successful laparoscopic urological operation was a nephrectomy and was performed by Clayman in America in 1990. In 1992 the first laparoscopic prostatectomy was performed and in 1993 the first laparoscopic partial nephrectomy.
Since then the development has been rapid and we can say that laparoscopic surgery is perhaps the most important development of General Surgery in the 20th century. In addition, the development of digital fiber optic technology, high-definition image processing, video and the optimization of laparoscopic mini-instruments have contributed to the fact that we are now talking about minimally traumatic invasive surgery with minimal complications and very good results comparable to those of open operations.
How is laparoscopic surgery performed?
Through a one-centimeter skin incision, a thin special lens, the laparoscope, is inserted into the abdomen and under direct vision, which is connected to a digital camera for live monitoring of the image on a high-definition screen. Inert gas is then injected under low pressure into the abdomen to create a pneumoperitoneum. Thus, a space is created between the abdominal organs and then 2–3 additional small skin holes are made, each half a centimeter. The special laparoscopic tools for performing the operation enter through them.
Examples of urological operations that can be performed laparoscopically are:
- Kidney-adrenal diseases
- Radical Nephrectomy for kidney tumor or non-functioning kidney
- Partial nephrectomy – removal of only the carcinoma and preservation of the kidney
- Peloplasty for stenosis of the pelivoureteral junction
- Adrenalectomy for adrenal diseases
- Partial or radical nephrectomy for kidney tumors
- Removal of renal cysts that cause pressure-obstructive phenomena
- Radical removal of the kidney and ureter together with part of the bladder surrounding the ureter in malignant tumors of the ureter or renal pelvis
- Bladder diseases
- Removal of diversions
- Radical cystectomy and creation of a new cyst from small intestine
- Prostate diseases
- Radical prostatectomy for prostate cancer
- Lymph node cleansing in cancer of organs of the urinary and genital system
- Treatment of varicocele
- Removal of retroperitoneal lymph node cancers of the testicles
- Gynecological diseases
- Treatment of relaxation of the gynecological organs
- Treatment of stress urinary incontinence
When don’t we do laparoscopic surgery?
In general, there are no major contraindications for performing laparoscopic operations except for patients with severe diseases of the circulatory and respiratory systems. Each patient must always be individually assessed in collaboration with the preoperative control team consisting of the anesthesiologist, the cardiologist, the pulmonologist and sometimes the pathologist-oncologist of the team in order to decide which surgical method is best for the patient.
Advantages of laparoscopic surgery
- Greater surgical precision
- Less blood loss
- Less postoperative pain, because there is no major trauma to the abdomen. Patients rarely need strong pain medication, can return to their normal activities and work more quickly, compared to open surgery
- Shorter hospital stay
- Better aesthetic result with smaller surgical scars
The oncological results of laparoscopic surgery are excellent and absolutely comparable to open surgery. Blood loss and perioperative morbidity are significantly lower than in open surgery. Due to the reduced surgical trauma, patients are mobilized and fed rapidly, have much less pain and leave the clinic faster (usually 1-2 days). The aesthetic result is clearly better, due to the small incisions, and the recovery period is short (1 – 2 weeks).
Based on the above, it is immediately obvious that laparoscopic methods are not new techniques nowadays, but there are more than 30 years of experience and results in all surgical specialties. This fact, combined with the advantages it provides, now makes laparoscopic treatment the method of choice in almost the entire spectrum of surgery and especially in urology. Particularly in malignant diseases of the urinary tract, worldwide, if feasible and if there is adequate knowledge and training, there is a prevalence of minimally invasive techniques such as laparoscopic surgery.