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Laparoscopic Urology

Urology deals with the surgical treatment of diseases of the genito urinary system - (kidney, ureter, bladder, penis & testis). 

Laparoscopic Urology achieves this through small key holes instead of large wounds on the body.What is Laproscopy Urology Instead of large incisions on the body, small 10 mm and 5 mm puncture wounds are made through which special telescopes and instruments are passed into the abdomen. The telescope will show the operative field on the monitor screen and watching this, the surgeon is able to use instruments through small key holes to perform many types of surgery.The first laparoscopic Nephrectomy was performed in 1990 by Clayman. At present, all genitourinary organs from kidney to prostate to bladder have been successfully ablated laparoscopically. Many complex reconstructive procedures such as pyeloplasties (surgery for obstruction of the kidney) can be effectively done laparoscopically. Large stones in the urinary system, which are difficult to tackle by ESWL can be removed by Laparoscopy. It is now fairly well accepted that the best method to bring down an undescended intra-abdominal testis is by laparoscopy.

What are the advantages of Laparoscopy? 
The creation of small keyholes as against large wounds for surgery, decreases the stress on the body and facilitates early recovery. There is less trauma to the internal organs and the magnification produced by the equipment, greatly facilitates precision of surgery. The patient remains less number of days in hospital and can return to work earlier than open surgery. The small incision of laparoscopy, decreases postoperative pain around 20 times less than open surgery. Even though the surgical expense of Laparoscopic surgery is more, the total cost of the treatment of the disease is usually 20% less than open surgery.

What are the disadvantages of Laparoscopy?
 There is a long learning curve for the procedure and hence cannot be offered by all departments. Expensive equipment and constant upgrading of this is required making it expensive for the hospital and the patient. However, the net cost of treatment of the disease for the patient is less expensive than open surgery.

What are the Operations done Laparoscopically Kidney?
The operation for removal of a kidney is called a Nephrectomy. This can be Simple, to remove normal tissue that is no longer working properly, or Radical to remove a tumour. The operation can be done from the front, called a transperitoneal approach, or from under the last rib on the affected side and this is called a retroperitoneal approach.Occasionally, the kidney needs to be removed along with the entire tube from the kidney all the way to the bladder (called a nephro-ureterectomy) and this operation often involves a small incision on the lower abdomen. The recovery from a laparoscopic nephrectomy is remarkably swift with many patients back to full activities within 3 weeks. They also suffer a lot less from the smaller scars than the conventional surgical scar.

The vast majority of baby boys are born with the testis already in the scrotum. Interestingly, the testis is formed inside the abdomen at the same height as the kidney. It migrates down to the scrotum of the foetus before birth. Occasionally the testis stop descending along the usual path and it is called “undescended.” Rarely the testis may migrate to an unusual place and is called “ectopic.”Between 1 and 2 years of age, the testis needs to be in the scrotum for normal sperm production. If the testis can be felt in the canal from the abdomen to the scrotum (called the “inguinal” canal) it is a minor procedure to bring it into the scrotum. However of the testis is in the abdomen, it is at risk of developing cancer and must either be removed or brought into the scrotum. As ultrasound and computer scans were unreliable to show the location of the testis, this was done by making anincision on the abdomen called a laparotomy.

The safest treatment for a varicose vein of the testis is embolisation done by an experienced radiologist. However, this procedure can prove very difficult if not impossible and it may fail from time to time. In this instance laparoscopy provides an ideal alternative form of therapy with excellent success rates and minimal side effects.