Laparoscopy in Urology

In last one decade, laparoscopy has become a practical and acceptable alternative to treat complex urologic surgical diseases. Most of the open procedures today are replaced by laparoscopic alternatives. The journey of laparoscopy started in 1991 by Dr. Ralph Clayman who performed the first laparoscopy nephrectomy. Laparoscopy has become a major domain of urological surgery and use of this approach has evolved to perform more extensive and complicated procedure. With the ongoing developments in this field, it would probably replace open surgical procedures in most urological fields.

Why Laparoscopy?

Laparoscopy offers a number of advantages to the patient. These include:

• Reduced blood loss, which reduces the chance of needing a blood transfusion.
• Smaller incision, which reduces pain and shortens recovery time, as well as resulting in less post-operative scarring.
• Less pain, hence less analgesics needed.
• Hospital stay is reduced significantly.
• Reduced exposure of internal organs to possible external contaminants thereby reduced risk of acquiring infections.

Commonly performed laparoscopic procedures are

• Simple nephrectomy for non-functioning kidney: may be related to long-term obstruction, stone or infection.
• Deroofing of simple renal cyst: sometimes needed for pain and infection in cyst.
• Radical nephrectomy for large renal tumors
• Partial nephrectomy for small renal masses
• Live donor nephrectomy for kidney transplant
• Pyeloplasty for congenital pelvi-ureteric junction obstruction
• Adrenalectomy for adrenal tumors
• Nephroureterectomy for upper tract TCC
• Orchidopexy for undescended testis
• Ureterolithotomy for very large stones
• Pyelolithotomy for very large and complex stones
• Ureterolysis for retro-peritoneal fibrosis
• Ureteric reimplantation
• Radical prostatectomy for prostate cancer
• Radical cystectomy for advanced muscle invasive bladder cancer
• Augmentation cystoplasty
• Vesicovaginal fistulas
• Ileal replacement of ureter
• Retroperitoneal lymph node dissection