Minimally Invasive Surgery - Laparoscopic Surgery

Laparoscopy is the use of scopes and small instruments through small, less than half-inch (or even quarter-inch), incisions to perform surgery.  Laparoscopy has commonly been used to perform gallbladder surgery. At Emory University, laparoscopy has evolved to become the preferred method for kidney and adrenal surgery and has broad applications for other types of surgery. 

The advantages of laparoscopy include smaller incisions to heal, less pain medication, a quicker recovery time, and better visualization by the surgeon using scopes and video that provides a magnified view of the area inside the patient's body.

 
Typical placement of small incisions (1/4 to 1/2 inch) are used to introduce instruments for laparoscopic surgery.  The typical flank incision for standard open surgery would be about 8-10 inches, extending into the rib cage area.

Not all patients are candidates for laparoscopic surgery, but most are. At Emory University, laparoscopic surgery for cancer, infections, stones and reconstruction have been performed routinely for the last several years. Laparoscopic nephrectomy (kidney removal), laparascopic adrenalectomy (adrenal gland removal), and laparoscopic pyeloplasty (kidney drainage tube reconstruction) have almost entirely replaced their open surgical counterparts. Emory University boasts two fellowship-trained laparoscopists, as well as a training program designed to teach laparoscopy to community and resident physicians.

There are several laparosopic procedures available at Emory Univeristy:

Laparoscopic nephrectomy (kidney removal) is the most common laparoscopic urologic procedure performed at Emory University. This can be performed either purely laparoscopically with a morcellation technique to remove the kidney, through a small well-placed incision to remove the kidney for cancer (radical nephrectomy), or through a hand-assisted method. For benign cases of kidney removal (stones, infections, diseased or shrunken kidneys), the kidney can be morcellated (broken up into smaller pieces) and removed without enlarging any of the small incisions. For tumor cases, the kidney is placed in a bag prior to removal through a small incision lower in the abdomen away from the muscles for less pain and better cosmetic appearance. The hand-assisted method allows the surgeon to place one hand inside the patient's body for better tactile sense. Emory urologists also perform kidney surgery via transperitoneal (through the abdomen) or retroperitoneal (from the back, behind the bowel cavity) approaches for patients with multiple previous abdominal surgeries. A typical hospital stay can be as quick as overnight or usually three days. 

Laparoscopic partial nephrectomy involves removing just the tumor rather than the whole kidney and sparing as much of the normal kidney tissue as possible. Partial nephrectomy for smaller tumors has been found to be a cancer treatment just as effective as a complete nephrectomy with the advantage of leaving the functional kidney behind. This is a more complicated and challenging operation and is limited to small well-placed tumors or diseased segments of the kidney.

Laparoscopic kidney tumor ablation is also an option for smaller tumors that are not easily removed by laparoscopic partial nephrectomy. Both techniques are kidney-sparing surgeries designed to produce minimal destruction of the normal kidney tissue. 

Cryosurgery  kidney tumor ablation involves the placement of small needles and the use of pressurized gases to freeze the kidney tumor to temperatures below -40 degrees Celsius. This is performed under laparoscopic guidance to visualize the tumor and ensure safety to the surrounding organs.

Radiofrequency kidney tumor ablation also involves the placement of an array of needles into the kidney tumor, which are then heated to 120 degrees Celsius to destroy the tumor cells. 

Laparoscopic pyeloplasty is reconstructive surgery of the junction between the kidney and ureter (kidney drainage tube). Congenital blockages or scar tissue from kidney stones may cause a blockage of the kidney and drainage tube, which over time can lead to flank pain, kidney stone formation, severe infection and eventual destruction of the kidney. Laparoscopic pyeloplasty is a minimally invasive alternative to open surgery and has been found to be greater than 95 percent successful in curing these types of blockage. A typical hospital stay is overnight to two days. 

Laparoscopic adrenalectomy is the surgical removal of the adrenal gland, which lies above the kidney.  The most common reason for removal is benign growths of the adrenal that can cause high blood pressure, weight gain, unwanted hair growth, or electrolyte imbalances.  Laparoscopic adrenalectomy can also be performed for cancers such as pheochromocytoma, adrenal cortical carcinoma, or metastases from cancers from other organs. The length of the hospital stay for laparoscopic adrenalectomy depends on the cause for surgery. Overnight stays are routine, but longer stays are required for more difficult tumors. 

Laparoscopic Stone Surgery is an uncommon approach for kidney stone surgery.  The more usual procedures for stones, such as Shock Wave Lithotripsy (SWL), Ureteroscopy or Percutaneous Nephrolithotomy (PCNL), which are all performed at Emory University, have lessened the need for open stone surgery to well below 1 percent. Laparoscopic Stone Surgery is reserved for those rare instances where both reconstructive or cancer surgery and stone removal need to be performed at the same time.