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| Laparoscopic Urology |
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Minimally invasive surgery in urology is part of the cutting edge of surgery offered by urologists at the National Kidney and Transplant Institute.
The National Kidney and Transplant Institute is the pioneer hospital in the country doing laparoscopic surgery and have the largest experiences with this technique in the Philippines. It is fast becoming a popular surgical procedure which only this institute could offer.
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| Minimally invasive surgery, which has gained worldwide popularity, is set to revolutionize traditional open surgery. |
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What is Laparoscopic Urology? |
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Laparoscopic urology is a technique in performing major urologic surgery through several tiny “keyhole” (0.5cm to 1.0cm) incisions, instead of the long incisions, at least a foot, that have been traditionally used. Laparoscopy uses a camera that is inserted inside the abdomen through one of the small incisions so that organs can be visualized using a 5 to 10 mm. telescope, and manipulated with long thin instruments likewise inserted into the abdomen through small incisions.
Although in essence this technique employs keyhole surgery, the view obtained is much better than looking through a keyhole. Modern camera equipment produces a wide, bright, clear, magnified view of the operation.
Additionally, though using only small incisions, laparoscopic surgery requires general anesthesia like open surgery.
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hand instruments in lap surgery |
insertion of ports
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insertion of ports |
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| What advantages can one gain from this kind of procedure? |
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Many documented benefits have been demonstrated compared with the traditional open surgery.
- Because of the small wound size, this technique produces much less pain thus requiring less pain medications
- Less blood loss
- Shorter hospital stay
- Favorable cosmetic result with smaller scars
- Recovery time greatly reduced resulting to earlier return to work and normal daily activities
There is also evidence that the chemical changes which occur in the body after surgery secondary to stress are not as pronounced and the likelihood of chest complications is lower.
Whatever is the goal of open surgery can also be achieved using laparoscopic surgery
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incision wounds of laparoscopy |
incision wound of conventional open surgery
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| What procedures can be done using laparoscopy? |
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The procedures being done laparoscopically are:
- Laparoscopic lymph node dissection
- Laparoscopic adrenalectomy
- Laparoscopic cyst unroofing/decortication
- Laparoscopic nephrectomy
- Laparoscopic partial nephrectomy
- Laparoscopic nephroureterectomy
- Laparoscopic radical nephrectomy
- Laparoscopic donor nephrectomy
- Laparoscopic pyeloplasty
- Laparoscopic radical prostatectomy
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Specimen obtained by laparoscopy |
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| What are the contraindications of laparoscopic surgery? |
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Absolute contraindications: |
- Uncorrected bleeding dyscrasia
- Bowel obstruction
- Abdominal wall infection
- Malignant ascites
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Relative contraindications: |
- Prior abdominal surgery
- Morbid obesity
- Ascites
- Pregnancy
- Active chronic obstructive pulmonary disease (COPD)
- Severe heart disease / arrythmias
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| What are the possible complications of laparoscopic surgery? |
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The estimated complication rate of laparoscopic urologic surgery is less than 5%. The most common risks include bleeding, infection, and injury to adjacent organs such as liver, bowel, spleen, pancreas and vascular structures. It is worthy to note though that these complications do also happen with open surgery.
There had been no incidence of death in our institute’s experience.
Conversion to open surgery after initial attempts of laparoscopy are sometimes necessary to safely complete the procedure but is never considered a failure of surgery.
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| What is the disadvantage of laparoscopic surgery? |
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Although laparoscopic surgery is easier on the patient than open surgery, it is technically more difficult to perform than that of equivalent traditional open surgery that it sometimes takes longer time to perform. |
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| Laparoscopic milestones at National Kidney and Transplant Institute |
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| 2001 |
first laparoscopic pelvic lymph node dissection.
first laparoscopic hand-assisted nephrectomy |
| 2002 |
first laparoscopic adrenalectomy
first full laparoscopic nephrectomy |
| 2003 |
first full laparoscopic radical nephrectomy |
| 2004 |
first laparoscopic donor nephrectomy
first laparoscopic radical prostatectomy |
| 2005 |
first laparoscopic orchiectomy for undescended abdominal testis |
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| The Future: |
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The Department of Urology at National Kidney and Transplant Institute has a long history of innovation in minimally invasive surgery as it remains to be in the forefront of developing this exciting, beneficial to the patients, subspecialty area of urology.
For more details on these procedures, please contact our Urology Department office. |
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