Laparoscopic surgery, more popularly known as keyhole surgery or minimally invasive surgery, wherein complex surgeries are performed through tiny centimeter incisions that has revolutionized the surgical approach for many conditions. In Urology, Laparoscopic surgery finds applications in many scenarios.
What are the advantages of Laparoscopic surgery?
- Faster recovery
- Shorter hospital stay
- Better cosmesis
- Less pain or Painless surgery
- Earlier return to work or normal activity
- Earlier return to exercises
Applications in Urology
- Adrenal glands: Adrenalectomy, Adrenal tumor/cyst excision
- Kidneys: Removal of the kidney (non-functioning kidney, Kidney cancer: partial or complete removal, kidney removal in donor for the transplant)
- Ureter: Pelvic-ureteric junction obstruction, Removal of large > 2 cm stones from the ureter, ureteric stricture
- Bladder: Removal of bladder partially or completely (in muscle-invasive bladder cancer)
- Prostate: Removal of Cancerous prostate
- Testis: Undescended testes surgery, varicocele surgery
All abdominal surgeries that were once performed through open surgery have now been performed with laparoscopic surgery. The fact that major surgeries can be done with minimal morbidity, good cosmesis and early return to work have popularised this approach.
Urologists who have been trained in laparoscopic surgery have to perform these surgeries. There is a steep learning curve and not all centres can provide this facility. As a patient, it is important to choose the right centre for laparoscopic surgeries.
Laparoscopic surgeries in Children
Many of the conditions listed above can occur in children too. Laparoscopic surgeries are possible in children and have the distinct advantage of quicker recovery and lesser time lost from school and sports. This is a major psychologic and physical advantage for the kids.
What to expect before and after Laparoscopic surgery?
Once the Urological surgeon has diagnosed the condition and has planned the surgery, a few blood tests and radiologic investigations will be done. The patient will be assessed by the Anesthesiologist to evaluate fitness for General anesthesia. A Cardiologist may be required to certify fitness, especially in elderly patients. Duration of the surgery varies and can range between 1-4 hours depending on the procedure. The patient is provided with painkillers after the surgery and can be mobilised for 6 hours post-procedure. Oral liquids can be had from 4 hours after procedure and solids from the next day following the procedure. Discharge generally takes 1-3 days post-surgery for most conditions. Rest at home between 1-2 days and return to work after that should be possible in most cases. Stitch removal is generally not required self-absorbing stitches are used on the skin.
Dr. Vikas Jain, Senior Consultant and Director, Urology and Renal Transplant, Narayana Superspeciality, Gurugram and Dharamshila Narayana Superspeciality Hospital, Delhi
Dr. Ashwin Mallya, Consultant, Urology and Renal Transplant, Narayana Superspeciality, Gurugram