Laparoscopic Surgery Overview
Many traditional urologic surgical procedures require large incisions with lengthy hospitalization and recovery. Minimally invasive surgery, also often known as laparoscopic or keyhole surgery to patients has recently been developed in the field of urologic surgery with the advancement of engineering and computer technologies. Using a small telescope with built-in magnification mechanism and a variety of long, thin surgical instruments placed through approximately 3-5 incisions (each of which is usually no larger than a dime in size), the surgeon is able to perform minimally invasive surgery for a variety of urologic diseases and problems.
Adrenal Center surgeons remove the vast majority of adrenal tumors laparoscopically. In a laparoscopic adrenalectomy, the adrenal gland is removed through 3 or 4 very small incisions (each about ¼ to ½ inch in size) and removing the adrenal gland using a small camera and special instruments. Laparoscopic adrenalectomy offers the shortest recovery time and the least amount of postoperative pain. Most patients may leave the hospital within a day or two of the operation. In general, tumors that are smaller than 10 cm in size with a low risk of being adrenocortical cancer can be removed laparoscopically. Approximately 2% of laparoscopic operations need to be converted (i.e. changed over to) to the traditional open incision. The most common reasons to convert to an open operation include: signs of cancer, unexpected findings, difficult anatomy, a tumor that is larger than expected, and a tumor that is stuck (i.e. invading into) surrounding organs.
Laparoscopic radical nephrectomy: Laparoscopic nephrectomy is performed using telescopes that are inserted into the abdominal cavity through small “key hole” incisions; however, a somewhat larger incision is often made to permit removal of an intact kidney. Nephrectomy performed by inserting the telescopes into the cavity that surrounds the kidney (rather than into the abdominal cavity) is called retroperitoneoscopic nephrectomy.
Current data indicate that open and laparoscopic radical nephrectomies have similar complication rates and provide equally effective cancer treatment for patients with tumors that appear confined to the kidney. Compared to open radical nephrectomy, laparoscopic radical nephrectomy has less postoperative pain, shorter hospital stay and shorter recovery time. If you elect to undergo a laparoscopic radical nephrectomy, there is a low risk (usually less than five percent) that the surgeon will need to convert to an open nephrectomy (i.e., convert the “key hole” incisions to a larger incision). Not all patients are candidates for laparoscopic nephrectomy. Laparoscopic radical nephrectomy is best suited for small, localized tumors that have not invaded the lymph nodes or renal vein. Open nephrectomy is preferred in patients with severe scarring around the kidney or a history of extensive abdominal surgery. Surgeons who are experienced with retroperitoneoscopy may consider this approach in patients with a history of extensive abdominal surgery.
Laparoscopic and retroperitoneoscopic partial nephrectomy: Information is accumulating on laparoscopic (or robotic) and retroperitoneoscopic partial nephrectomy and these are good approaches in many patients. In general, this approach is best suited for relatively small, peripherally located tumors that are relatively easy to remove and for which reconstruction of the kidney is straightforward.