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Background of Laparoscopic Surgery
The word "laparoscopy" means to look inside the abdomen with a special camera or scope. Laparoscopic surgery involves filling the abdomen with gas to create an adequate space in which to work and performing surgery by making small cuts and placing instruments and cameras through small 1/4 inch port-holes. Laparoscopic surgery has been around for over 25 years and is minimally invasive way for surgeons to perform surgery with less pain, less bleeding, and often better outcomes due to improved vision and precision. Laparoscopy has been referred to as the "Band-Aid surgery" because the size of the cuts that are used to place the instruments into the abdominal cavity are small enough to be covered by a band-aid. As technology has progressed and as surgeons have advanced their skills many more procedures have become available to patients to be done laparoscopically. Laparoscopic surgery is not experimental, its reliability, safety, and patient benefits have been proven by experienced surgeons across the world. As you consider laparoscopic surgery for yourself remember that your surgeon's laparoscopic surgery experience is the key to reducing your risk and improving your likelihood of a successful outcome.
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Dr. William Schusseler from San Antonio began removing pelvic lymph nodes in patients with prostate cancer in late 1988 and in the 1990's urologic surgery was revolutionized by two exciting developments in laparoscopic urology. The first of these developments occurred in 1991 when Dr. Ralph Clayman at Washington University in Missouri removed the first kidney tumor laparoscopically. Dr. Richard Chopp brought this urologic laparoscopic technique as well as the technique of laparoscopic lymph node dissection to Austin in 1991 and has since been joined by Dr. Stephen Hardeman and Dr. Bryan Kansas performing laparoscopic kidney surgery at The Urology Team.
The second development occurred in 1998 when Dr. Bertrand Giullonneau and Dr. Guy Vallencien in Paris, France developed a technique to remove cancerous prostates laparoscopically. This technique was further refined by the introduction of the da Vinci robot (link to that portion of our web page) which added better vision and improved precision for the operation. Dr. Fagin, here at the Urology Team, trained with Drs. Guillonneau and Vallancien in Paris, France as well as with the Head of Minimally Invasive Urology at The Cleveland Clinic. Dr. Fagin has performed over 1000 da Vinci Robotic surgeries since September 2004 to the present. He performs more da Vinci Robotic surgeries than any other single Urologist in Texas (click here to read intuitive letter).
Since it's introduction in 1998 the demand for this operation has increase by over 300% per year with over 33,000 men world wide having undergone this surgery. There is overwhelming evidence showing that men who undergo laparoscopic da vinci® robotic prostate surgery have
- less blood loss,
- less pain,
- shorter hospital stays,
- earlier removal of their urethral catheters, and
- an equal if not better total cancer removal rate.
Many data series, including that of Dr. Fagin, also report
- a faster return of urinary function and
- more reliable return of erections with the laparoscopic da vinci technique.
Laparoscopic da vinci® robotic prostate surgery has been touted as the most challenging laparoscopic surgery in Urology.
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Benefits of Laparoscopic Surgery
The specific advantage to the patient with laparoscopic surgery is that it achieves the same end result as open surgery but it converts an operation that would traditionally need to be done through a long cut in the abdomen into one done through a few small cuts.
These small cuts are
- less painful for the patient and
- dramatically speed their recovery,
- they return to home from the hospital faster
- and return to regular activities when they return home.
In addition, laparoscopic surgery often results in less blood loss during the operation and many surgeries can be done with more precision due to the magnification of the scope used.
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The risks of laparoscopic surgery are identical to that of open surgery in that there is a risk of bleeding, infection, and damage to other organs and structures that lie near the area of operation. These risks are typically less than what one would see with traditional "open" surgery. In addition, a laparoscopic procedure may be converted to an open procedure if the surgeon feels that it is unsafe to proceed laparoscopically. You should consult a Urologist knowledgeable in laparoscopic surgery to discuss the risks specific to each operation and we recommend that you should choose a physician with advanced training in this procedure.
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Patient Evaluation for Laparoscopic Surgery
Your Urologist will have a thorough discussion with you to determine whether laparoscopy is appropriate for your specific Urologic condition. This will, of course, include a physical examination, a description of the procedure itself, and a discussion of the risks and benefits.
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You will receive instructions that need to be followed prior to your laparoscopic surgery. Some laparoscopic surgeries require that the intestines be empty of any gas and food and therefore patients may be placed on a clear liquid diet for two or three days prior to the surgery.
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Patients undergoing laparoscopic surgeries receive general anesthesia by the anesthesiology team. The abdomen itself is then expanded by filling it with carbon dioxide. Carbon dioxide is a safe gas, which is easily exhaled through the lungs. With the abdomen temporarily expanded, small cuts are made in the abdomen through which ports are placed. These ports serve as entryways into the abdomen for the placement of delicate instruments to perform the surgery and a telescopic camera that magnifies and monitors the progress of the surgery. Under magnification diseased organs can be examined, repaired, or removed with minimal trauma to the nearby structures. At the end of the procedure if an organ was removed it is taken out of the belly in a water tight bag, the carbon dioxide gas is let out of the abdomen, and the various port sites are closed with internal stitches. In general, patients go home within 23-48 hours depending upon the type of surgery they had done.
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Over the past ten years advances in technology have been coupled with advances in the skill of dedicated surgeons allowing laparoscopic surgery to become the procedure of choice for many operations. Currently, laparoscopy is used to remove kidneys, prostates, lymph nodes, and adrenal masses, and is used for various reconstructive urologic procedures. Many urologic surgeons coming out of their training have already had some exposure to laparoscopy. However, be sure that your Urologist has had both extensive training and experience in the specific fields of urologic laparoscopy that pertain to you.
At the Urology Team, Dr. Hardeman and Dr. Kansas provide laparoscopic kidney surgery to Austin, Texas. Dr. Fagin has performed over 1000 laparoscopic da vinci® prostate surgeries since September 2004 to the present.
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