Laparoscopic Urological Procedure

Renal Sciences | Posted on 05/11/2020 by Dr. Devendra K. Sharma

Laparoscopy is a surgical diagnostic procedure used to examine the organs inside the abdomen. It’s a low-risk, minimally invasive procedure that requires only small incisions. Laparoscopy uses an instrument called a laparoscope to look at the abdominal organs.

The procedure takes its name from the laparoscope, a tool that has a tiny video camera and light on the end. When a surgeon inserts it through a small incision into your body, they can look at a video monitor and see what’s happening inside your body.

Laparoscopic entry with regard to urologic illnesses might be received via several routes viz. transperitoneal, retroperitoneal, and extraperitoneal, peritoneum is the membrane covering the abdomen.

Laparoscopic surgeries have been performed as early as the 20^th century. However, technical limitations prevented the widespread use of the technique.

Laparoscopic and robot-assisted approaches in urology have fostered significant advances in minimally invasive surgery and in some instances completely replaced previously performed standard open procedures such as robotic prostatectomy and laparoscopic live-donor nephrectomies.

Types of urologic laparoscopic surgeries

Transperitoneal approach: A pneumoperitoneum is established prior to a laparoscopic procedure. Pneumoperitoneum means the presence of gas in the peritoneal cavity. Usually, CO2 is used for insufflation in laparoscopy.

Extraperitoneal approach: In the extraperitoneal approach, ample space is not available as compared to the intraperitoneal approach, and therefore space is artificially created. A small incision is made at the 12th rib in the mid-axillary line; then mostly a balloon dilatation is performed for making room for the surgery.

There are a number of operations that can be performed laparoscopically in urology disorders some are-

• Adrenal Gland, Laparoscopic approach to the adrenal gland has been used for various benign adrenal diseases.
• Kidney and Ureter, Simple Nephrectomy and Nephroureterectomy, Radical Nephrectomy
• Laparoscopic Surgery for Female Urology, vaginal prolapse, Laparoscopic repair of vesicovaginal and vesico­ureterine fistula
• Urological Laparoscopic Surgery in Renal Transplantation
• Removal of the gallbladder (laparoscopic cholecystectomy),
• Repair of hernia (laparoscopic hernia repair).
• Removal of the spleen (laparoscopic splenectomy).
• Removal of part of the liver (laparoscopic hepatectomy).
• Removal of part of the pancreas (laparoscopic pancreatectomy).

Why and when is urologic laparoscopic surgery advised?-

Urologic laparoscopy is often used to identify and diagnose the source of pelvic or abdominal pain. It’s usually performed when noninvasive methods are unable to help with diagnosis.

Laparoscopy is performed when these tests don’t provide enough information or insight for a diagnosis. The procedure may also be used to take a biopsy, or sample of tissue, from a particular organ in the abdomen.

By observing these areas with a laparoscope, your doctor can detect:

• An abdominal mass or tumor, Fluid in the abdominal cavity, or Liver disease.
• The effectiveness of certain treatments.
• The degree to which a particular disease has progressed.

Advantages of Laparoscopic Urological Surgery-

The most significant advantages of laparoscopic urological surgery include:

• Reduced Bleeding: This reduces the chances of requiring a blood transfusion.
• Smaller Incision: This not only reduces pain but also shortens recovery time, resulting in less post-surgery scarring and surgery marks.
• Less Pain: Because it is a minimally invasive surgery, patients experience minimal pain.
• Short Hospital Stay: Although the surgery time is usually slightly longer, the hospital stay is comparatively less, some patients are even discharged on the same day.
• Reduced Risk of Catching Infections: The surgery decreases the exposure of internal organs to external contaminants thereby reducing the risk of catching secondary infections.

Some of the challenges of Urologic Laparoscopic surgery are it is technically more demanding and requires a specialized team with a skill set and experience, it is also slightly more expensive but the advantages outweigh the challenges.

General Precautions post Laparoscopic Urological Surgery

• Activity is important after any surgery, slow activity is good for your healing process after Urologic Laparoscopic surgery.
• Bowel Function, due to the anesthesia given during your surgery and the pain medications used during and/or after surgery, normal bowel function is depressed.
• Catheter, a urinary catheter is used after surgery some patients only require this for a day or two after surgery. It will be removed and we will make sure you can urinate on your own without any problems prior to your discharge from the hospital.
• Constipation is fairly common after surgery a stool softener may be prescribed while in the hospital. 
• Fluids, drink plenty of fluids as you recover as long as you do not have any fluid restrictions. Water is recommended.
• Pain Control, anti-inflammatory pills, or non-narcotic medications may be prescribed as per requirement.