Procedures

Patients with early stage prostate cancer have a variety of treatment options, including radical prostatectomy. This operation can be performed laparoscopically with or without the use of a robot.

The benefits over open radical prostatectomy include less intra-operative blood loss with lower risk of needing a blood-transfusion, less post-operative pain, earlier discharge from hospital, earlier removal of the transurethral catheter and quicker return to normal activities such as work and sport.

During this procedure, one 1.5 cm incision (for the laparoscope) and two 1 cm incisions (for the surgical instruments) are made in the flank (compared to a 15-20 cm incision used in open surgery). After the kidney has been dissected and its blood supply severed, it is placed into a retrieval bag and removed through a 6-7 cm incision in the lower abdomen, similar to an incision for removal of the appendix. Non-functioning diseased kidneys and kidneys with tumours can be removed this way. Extremely large kidney tumours and severely infected kidneys may not be suitable for laparoscopic nephrectomy.

During partial nephrectomy, only the tumour is removed and the rest of the kidney is preserved. Not all tumours are suited to partial nephrectomy.

This operation is indicated in patients with congenital pelvi-ureteral junction obstruction. In this condition, there is a narrowing of the upper part of the ureter (the muscular tube that propels urine from the kidney to the bladder). Patients may present with pain or urinary tract infections. During laparoscopic pyeloplasty, one 1.5 cm incision (for the laparoscope) and two 0.5 cm incisions (for the surgical instruments) are made in the flank or the abdomen (compared to a 15-20 cm incision used in open surgery). The narrow part of the ureter is excised and the normal, healthy ureter is re-sutured to the collecting system of the kidney.

Most kidney cysts do not need surgical treatment. However, if the cyst causes complications such as pain, infection or obstruction of urine drainage, it is drained with a thin needle through the skin under ultrasound guidance (percutaneous drainage). If this procedure fails, a laparoscopic drainage can be done. During laparoscopic cyst drainage one 1.5 cm incision (for the laparoscope) and two 0.5 cm incisions (for the surgical instruments) are made in the flank (compared to a 15-20 cm incision used in open surgery). Part of the cyst wall is excised to ensure that the cyst cannot fill up again with fluid.

Most ureteral stones can be removed endoscopically, using instruments that are passed through the bladder, requiring no skin incision. Sometimes, these stones are too large or too stuck to be removed endoscopically. Traditionally, an open ureterolithotomy requiring an open incision in the flank (10 cm or larger) would then have to be made to cut the stone out of the ureter. During laparoscopic ureterolithotomy, one 1.5 cm incision (for the laparoscope) and two 0.5 cm incisions (for the surgical instruments) are made in the flank, the stone is removed with the laparoscopic instruments and extracted through the 1.5 cm incision.

If a testis has failed to descend fully, an operation may be required to establish its location and reposition it into the scrotum. This can be done laparoscopically by making one 1.5 cm incision (for the laparoscope) and two 0.5 cm incisions (for the surgical instruments) in the lower abdomen. This operation is sometimes done as two separate procedures to attain the best result.

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