Laparoscopic urologic surgery is a surgery where a doctor corrects urological issues without causing much agony to the patient. It is a minimally invasive surgery that involves the use of a laparoscope which has an inbuilt camera and several long and thin surgical instruments. It is inserted into the body through small incisions. With this surgery, patients experience a much better post-operative pain control, short hospitalization, quick recovery period and better results.
Nowadays, robotic technology is implemented in laparoscopic urologic surgery. Robotic surgery provides much better visualization and enhanced dexterity to the surgeon. Robotic technology has gained popularity especially in radical prostatectomy for prostate cancer.
Wide ranges of benign and malignant urologic conditions are treated using laparoscopic urologic surgery. Most commonly Pyeloplasty, Nephrectomy, Partial Nephrectomy, Radical prostatectomy and Radical Cystectomy are performed laparoscopically.
Standardized imaging procedures are of utmost importance. The decision for most of the surgical procedures depends mainly on the results of certain preoperative imagings. At times, affected organ size may be a hindrance to laparoscopic surgery. For example, if in kidneys, the renal tumors are very large then the space required for mobilization of the specimen is restricted. Similarly, if an adjacent organ is pathologically enlarged, then the surgical space is reduced which further restricts a surgeon to perform laparoscopic surgery.
It is the responsibility of the doctor to inform the patient about the possible operative risks involved with the surgery. The patient must be aware that certain conditions like fibrosis or adhesions that cannot be rectified through laparoscopic surgery and the surgeon might need to convert to an open surgery.
Although comparatively less blood loss is associated with laparoscopic approach, the surgeon makes sure that packed red blood cells are available prior to the surgery, whenever expected.
Patient Positioning
The patient’s position depends on the selected surgical procedure. A transperitoneal approach is used for any adrenal or renal dissection. In this approach, the patient is placed in a modified lateral position permitting easy access to the abdominal cavity. In retroperitoneoscopic approach, the patient is in a stiff lateral position. The decision of going for retroperitoneal or transperitoneal approach totally depends on the surgeon. Pelvis procedures such as prostatectomy require a specialized position called as Trendelenburg, where the leg is in an elevated position and head is down.
Technique Approach
Two things are kept in mind before the surgery, one is excellent visualization, and the other one is the duplication of open surgery principles. Similar to an open surgery, laparoscopic devices are composed of scissors, dissectors, vascular staplers, graspers, scalpels and more. The only difference is that they are simply elongated. Whenever, laparoscopic procedures require specimen retrieval, it is achieved using a specimen retrieval bag. It is inserted through the port and then unfolded in the surgical space. The specimen is entrapped in the bag, and then it is closed for extraction. Once the specimen is extracted, the laparoscope is re-introduced to verify the presence of bleeding. In order to control any sort of unexpected bleeding, the ports are removed under direct vision. The pneumoperitoneum is deflated before the removal of the last trocar. These small incisions are then closed similarly as performed in an open surgery.
Post-operative complications are usually very less in expert hands. Patients should take note of any abnormal sensation post laparoscopic surgery. If bowels are injured thermally or mechanically, then symptoms will generally occur in several days. In case of any bladder lesions caused during the surgery, the patient may develop urinary ascites. Laparoscopic surgery is known for its limited post-operative pain. If pain persists, the patient should consult the doctor as incomplete deflation may cause some pain in the shoulder girdle.
The most significant advantages of laparoscopic surgery include:
As mentioned earlier, laparoscopic urologic surgery is well known for its minimal post-operative pain. It is one of the most important aspects in the field of surgery as patients are more concerned about post-operative care than the surgery itself. Hence laparoscopic urologic surgery provides the perfect attributes for patients. It nullifies the use of epidural catheters or controlled analgesics. Oral nutrition is started the very next day. A single shot of antibiotic prophylaxis is administered prior to the surgery which is not required later. Routine lab tests are performed on the same evening and the next morning which helps the doctor to monitor the patient, if required.
