Laparoscopic Kidney Surgery

Laparoscopic surgery is a technique of performing surgeries with the most modern specialized surgical instruments in which the surgeon puts in a camera in the patient's abdomen and operates upon the different organs situated inside. Laparoscopic operations are performed through very small incisions hardly 5mm to 10mm, which result in minimal scarring and are extremely comfortable to the patient. In this technique placing a small high definition camera through a small incision, which is barely visible after six months, does the entire operation. The advantage of using this high definition camera is that it gives an immensely crystal clear view inside the body so the operations are done with extreme precision and can also reach areas, which are difficult to reach during open surgical operations.

The laparoscopic surgery evolved in the nineties, with the gall bladder and appendix being the earliest operations being done by this technique. There was an era when most of the gall bladder operations were done by traditional open surgery by a long incision over the front of the abdomen, but now most of the patients would want their gall bladders to be removed Laparoscopically. The greatest advantage of Laparoscopic surgery is that it requires a very small incision for very complex high end surgeries. It is specially important in urological operations. A traditional open surgical incision in the kidney requires cutting of the strong muscles of the back as well as the stomach on the front. Since the incision stretches from the back up to the front so the length of the traditional incision is usually between 20-30cms. It requires muscles being cut so is more painful for the patient. It also requires cutting of the 12th rib for exposure of the kidney so all the way is much more painful. In laparoscopic urological surgery all these problems are avoided since the incision is usually 2-3 cms in most of the kidney and ureter operations.

After laparoscopic surgery the patients can go home early, require less amount of painkillers an the incision heals very nicely. Since the incision is small it never leads to development of hernia in future. Another advantage to the patient is that the patient starts eating up early after the operation and there is less bleeding so usually blood transfusion is not required. After the surgery the patient usually goes back home in two days and can resume his daily routine work or can join office after a week. In open surgery since the incision is long and takes more time to heal, so usually they are discharges after 4-5 days and can not resume work by even two weeks. In fact the actual healing of the incision takes around 6 weeks to six months. The main advantage to the surgeon is that with the help of the high definition camera the vision is very clear and the field of vision is also extensive. Since in the open surgical operations the vision gets limited in the peripheral areas, this form of surgery is better in that aspect. In today's date almost all leading specialist centers have started such kinds of operations for the kidney.

The recovery in most of the cases is usually fantastic and most of the patients start eating after a day and gets discharged from the hospital after two days of surgery. In laparoscopic surgery the entire operation is done by inserting specialized instruments through 5-10mm incisions.

Nowadays most of the abdominal operations are done Laparoscopically with the removal of the gall bladder being the most common. Almost all the abdominal operations which were earlier done by open surgery such as removal of the uterus, ovaries, intestinal operations, stomach, liver, spleen etc are now done Laparoscopically at specialist centers. Kidney surgery is a form of superspeciality surgery and requires high-end laparoscopic instruments and expertise is also done Laparoscopically. In the twenty first century the technique of laparoscopic kidney surgery has evolved and has now been well established and standardized and has now reached the level of perfection. Now almost all the operations in the kidney can be done by utilizing high end laparoscopy.

Almost all kinds of diseases of the urinary system such as the kidneys, ureters, urinary bladder, prostate and the urethra can be done by either endoscopy or laparoscopy. Hardly 5% of ailments of the kidney require open surgery in the present scenario. The various operations of the kidneys which are done Laparoscopically include removal of kidney tumors or cancers, kidney, ureteric or bladder stones, all kinds of obstructions to the kidney such as pelviureteric junction obstructions and strictures, all kinds of kidney cysts including the infective Hydrated cysts and removal of the hydronephrotic or non functioning kidneys due to stones, obstruction or infections. Similarly operations of the removal of the prostate can be done Endoscopically or Laparoscopically.

The most important symptoms include poor flow of urinary stream, urine coming in drops, not able to empty the bladder completely, feeling of straining while, passing urine, going for urination again and again and getting up several times in the night to pass urine. Many a times patients may have a strong desire to pass urine but they are unable to do so. At times they may even have very severe urgency to pass urine but they pass only a few drops. They may have blood in urine or pus in urine and can have pain when they are voiding. Other symptoms suggestive of kidney diseases include, pain in the sides of the abdomen, fever with burning in urine or passing less amount of urine. Usually a healthy person should pass around 1.5-2.5 liters of urine in a typical day. The urine output may start going down slowly and the patient may be completely ignorant about it until it falls to less than half a liter in a day. Other features of advanced kidney failure include swelling of the body and the eyes and difficulty in breathing.

A variety of urological problems occur with rising incidence in this part of northern India especially the kidney cancers. Most of the kidney tumors detected today are in asymptomatic healthy individuals. The tumor is detected incidentally when they undergo an ultrasound routinely for some other purpose. The other most prevalent disease is the kidney stone disease. Due to a variety of lifestyle changes the kidney stone disease incidence is on rise. Even there are so many children getting affected by kidney stones. If the stones are formed in younger individuals who are less than thirty years of age they have a high chance of forming the stones again even after treatment. Such patients should undergo detailed blood and urine tests to find out why the stones are being formed repeatedly.

Kidney cancer is one disease in which the treatment has undergone a sea change in the last decade due to various advances in imaging, laparoscopic surgery and medical management. Now about a third of kidney cancers are detected on a routine ultrasound incidentally. Most of the early kidney cancers can be radically treated by minimally invasive methods such as laparoscopically or retroperitoneoscopically. The patient's recovery is hastened and he/she goes back home with a minimum scar. State of the art Laparoscopic surgery provides the best cancer control, gives minimum discomfort to the patient as the patient becomes ambulatory the same day surgery is done and can start taking orally in a few hours or on the first day after surgery.

Yes, since the person who is donating his/her kidney is an absolutely healthy person, so we prefer to do the operation Laparoscopically so that he does not have any problem in his future life. The incision heals relatively smoothly and since no muscles are cut the donor can do whatever he/ she wants after a week of surgery.