Laparoscopic and robotic surgeries
Laparoscopy is a minimally invasive alternative to standard open surgery in which a special camera, called a laparoscope, is used to produce an inside view of the abdominal cavity. This surgery is a minimally invasive procedure that consists of several small (1/2- to 1-inch) incisions rather than a single large one in the abdomen. Laparoscopic surgeries have led to less invasive cancer surgeries with decreased pain and faster recovery times for patients. Because of the reduced size of the incisions, hospital stays are often shorter, with some patients going home the next day.
Laparoscopic surgery can be used for the following urologic procedures:
- Radical nephrectomy for cancer (Removal of the entire kidney)
- Radical nephroureterectomy for cancer (Removal of the entire kidney and the ureter which connects to the bladder)
- Partial nephrectomy for cancer (Removal of only part of the kidney)
- Radical prostatectomy for prostate cancer (Removal of the prostate for cancer)
- Live donor nephrectomy for transplantation
- Pyeloplasty for ureteropelvic junction obstruction (UPJ obstruction)
- Ureteral surgery for stones or strictures
- Pelvic lymph node dissection
- Adrenalectomy (Removal of the adrenal gland)
During laparoscopic surgery, several long thin instruments, including a lighted camera called a laparoscope, are inserted into the patient’s abdomen through small incisions. These instruments include scissors, graspers, and other instruments modeled after the typical instruments used in traditional open procedures.
There are certain limitations to laparoscopic surgery because the surgeon does not have direct contact with the patient’s organs.
- The surgeon has limited range of motion due to the instruments being rigid and straight. Unlike the human hand and wrist, the laparoscopic tools can only move in certain directions, limiting the types of actions that can be performed.
- The surgeon relies upon a two-dimensional screen displaying the patient’s anatomy creating a loss of depth perception and impact on hand-eye coordination. A new alternative to laparoscopic surgery, which is increasing in popularity, is robotic-assisted surgery.
Robotic surgery can help surgeons overcome many of the challenges presented by the open or laparoscopic surgery. The daVinci robotic system is similar to the laparoscopic surgical platform in that long, thin instruments resembling traditional surgical instruments are inserted into the patient through small incisions. Therefore the benefits of robotic and laparoscopic surgery are very similar: less pain, shorter hospital stays, and faster healing times.
The daVinci Surgical System can provide the surgeon with the range of motion, fine tissue manipulation capability and 3-D visualization characteristic of open surgery, while simultaneously allowing the surgeon to work through tiny incisions typical of laparoscopic surgery.
The daVinci system has three main parts:
- Console – where the surgeon sits to operate the robot
- Patient side cart – which is positioned over the operating table and contains the arms that hold the instruments
- Third cart – which provides a view of the surgery for the other doctors and nurses in the room.
When the surgeon looks into the console, he sees a three-dimensional view of the patient’s internal organs and the surgical instruments, similar to what he would see in an open operation. Unlike an open operation, the camera can magnify the image, creating better visualization. The arms of the robot are controlled by the surgeon using hand controls. Perhaps the largest advantage of the robot is in the design of the instruments. Unlike most laparoscopic instruments, which can only move in certain directions, the daVinci’s instruments are wristed. Which means that the surgeon can manipulate the instruments in multiple directions, giving the surgeon freedom similar to that of an open platform.
There are limitations to robotic surgery. Unlike an open operation, the surgeon cannot feel the organs. When using the instruments to touch the organs, there is no tactile feedback, so surgeons must be extra vigilant about where each instrument is, in order to avoid damage to the organs. Finally, the daVinci requires the use of instruments that are only manufactured by Intuitive Surgical, Inc. If a procedure requires an instrument that is not currently available through the manufacturer, that part of the procedure must be completed laparoscopically.