Laparoscopic Uro-oncology

Almost all urological cancers can be treated with laparoscopy.

Laparoscopic radical prostatectomy (LRP)

This is a type of keyhole surgery used to remove the prostate gland and the seminal vesicles as a treatment option for prostate cancer.

Traditionally radical prostatectomy was performed through a single incision that extended from the pubic bone to just below the umbilicus (belly button). This is not the case for LRP which uses instead, 5 small incisions through which ports or small tubes are placed. Specialized instruments and telescopic cameras are then inserted through the ports to perform the surgery in a precise manner facilitated by magnified vision.
The suitability of a man for this type of surgery will depend on several factors. Most importantly is the type of prostate cancer that a man has. This will be determined predominantly by three main characteristics:

  • Initial PSA
  • Gleason score (appearance of the prostate cancer demonstrated in the biopsies)
  • DRE findings (how the prostate feels when examined by the urologist)

The advantages of LRP are that of improved visualization, reduced post operative pain, a shorter hospital stay and a more rapid return to normal activity

 

Laparoscopic radical nephrectomy

Laparoscopic radical nephrectomy uses a minimally invasive approach (laparoscopy) to perform exactly the same procedure that is done in open radical nephrectomy. In any radical nephrectomy (open or laparoscopic) the entire kidney including the kidney cancer is removed. The operation involves removal of the kidney along with the fat around the kidney. All of this tissue is contained in a leathery layer known as Gerota's fascia. If the kidney cancer is quite large and near the adrenal gland which is adjacent to the kidney, the operation can include removal of the adrenal gland as well. The operation also often includes removal of the lymph nodes which are around the kidney.

The laparoscopic approach to partial nephrectomy means that no large incisions are required to perform the procedure. Instead of a large incision, three or four 1/2 cm to 1 cm incisions (less than 1/2 inch) are made. The spaces in the body are gently filled with gas to make working space and a small camera is placed into the body through one of the incisions. The other small incisions are used to place working instruments which can be used to perform the procedure.

The entire kidney with the cancer within and with the surrounding fat and the layer known as Gerota’s fascia are removed. Once the entire specimen has been separated from the surrounding tissues, it is placed in a bag while still inside the body. The bag is then removed by making an incision.