In recent years, due to the rapid development of modern technology, the type, quality and function of minimally invasive urological equipment are becoming more and more perfect, the indications for minimally invasive surgery are expanding and the complications are gradually decreasing, many hospitals with conditions have carried out such surgery and achieved good results. Recently, Guangdong media conducted a Q&A interview with Dr. Yang Guosheng, Director of Urology Department of Guangdong Second People’s Hospital, on issues related to minimally invasive urological surgery, which is excerpted below. Q: (Reporter, hereafter abbreviated): Many of us have heard of minimally invasive surgery, but the definition of minimally invasive is not very clear. A: (Dr. Guosheng Yang, hereafter abbreviated): There is no precise definition of minimally invasive, but many surgeons believe that minimally invasive should be able to achieve the therapeutic purpose with fast recovery and less trauma compared to traditional surgery. It is also important to note that if it only refers to a small incision without achieving the purpose of doing surgery or without achieving the same efficacy as traditional surgery, it cannot be called minimally invasive surgery. In general, I personally understand that minimally invasive surgery should be relative to traditional surgery, which has four major characteristics: small or no incision, less trauma, less pain, and faster recovery. These four points must be present at the same time. Q: What are the minimally invasive urological procedures? A: There are various types of minimally invasive urological surgery. I personally believe that minimally invasive urological surgery includes minimally invasive surgery with natural channels, minimally invasive surgery with artificial channels and minimally invasive surgery without channels according to the way of working channels. Minimally invasive surgeries with natural channels mainly include cystourethroscopy, transurethral resection of prostate, electrodesiccation of bladder tumor, ureteroscopic lithotripsy and so on. Minimally invasive surgeries with artificial channels mainly include urological laparoscopy and percutaneous nephrectomy, etc. Minimally invasive surgery without access mainly includes percutaneous renal cyst puncture, percutaneous renal tumor thermotherapy, etc. Among them, transurethral, transureteral, percutaneous renal and laparoscopic surgeries are most widely performed and most enthusiastic. Q: What are the main urological laparoscopic procedures? A: Urological laparoscopic surgery is a new technology that has emerged in the field of urology in recent years, commonly known as pinhole surgery, which represents the direction of urological development. Urological laparoscopic surgery is the patient receives surgical treatment is no longer the traditional sense of open surgery, but only in the abdomen with a puncture needle for two to four about 0.5 to 1.0 cm size incision, both will be connected to the television camera system laparoscope, and three trocar needle insertion, the surgeon is through the screen monitor to perform surgery. For this reason, laparoscopic surgery is also known as televised laparoscopic surgery. Posterior laparoscopic and laparoscopic urological surgery can be widely used in most urological treatments, such as adrenal tumor resection or total adrenalectomy, decompression of renal cysts, radical resection of renal cancer, radical treatment of renal pelvic cancer, ureterotomy for stone extraction, pelvic ureteroplasty, total cystotomy with bowel substitution for bladder, radical treatment of prostate cancer, testicular drainage for cryptorchidism, high ligation of varicocele, etc. Q: What are the characteristics and directions of current minimally invasive urological surgery? A: Minimally invasive urological surgery has entered a mature stage after nearly 20 years of development such as origination, emergence and climax. In China and even in the world, the main features are as follows: 1. Popularization. It can be said that almost 90% of urology or surgery departments in hospitals above county and city level have carried out minimally invasive urological procedures to varying degrees, among which transurethral resection of prostate and ureteroscopy are the most prominent. 2. Standardization. Compared with a few years ago when minimally invasive surgery was carried out in a variety of places, minimally invasive urological surgery has become more and more standardized in recent years with the development and promotion of urological guidelines and the implementation of standardized training and access system. 3. Minimally invasive surgery is a high degree of the same emphasis on the natural hand of the physician and the instrument hand and the corresponding instruments. With the continuous improvement and refinement of surgical instruments, minimally invasive urological surgery is also becoming more and more refined. 4, cutting-edge. With the extensive development of minimally invasive urological surgery, it can be said that almost 90% of urological normality diseases can be completed by minimally invasive surgical methods, including radical prostate cancer treatment, total bladder dissection urinary diversion, etc. Even some surgeries that could only be barely completed in open surgery can now be completed in a minimally invasive way, so it can be said that minimally invasive surgery has “lurked” in the treatment of almost all disease spectrum in urology. However, minimally invasive urological surgery is also developing to more sophisticated, such as standard robotic surgery, single-channel laparoscopic surgery, natural channel laparoscopic surgery, etc., which are also tried to carry out in the world. 5, dual recognition. After about 20 years of development, minimally invasive urological surgery has gradually become a mature and reliable surgical procedure, which has been recognized by the majority of medical personnel and the majority of patients, that is, I think “double recognition”. This recognition has been a rather difficult process, and now it has achieved a gratifying and desirable result. It is no exaggeration to say that 90% of young urologists are enthusiastic about minimally invasive surgery and 90% of patients are happy to be treated with minimally invasive surgery. Q: The major organs of the urinary system are mostly located in the retroperitoneum, can laparoscopic surgery be carried out well? A: The adrenal glands, kidneys, ureters, bladder and prostate of the urinary system are all retroperitoneal or extraperitoneal organs, and surgery can be performed via the peritoneal and retroperitoneal cavities. Retroperitoneoscopic surgery started in the late 1990s and is a different surgical approach compared to conventional laparoscopic surgery. Since the retroperitoneal space is a potential cavity, unlike the abdominal cavity which is extremely easy to inflate and expand, it is easy to observe and operate. Therefore, a space needs to be manually dilated, and within this space environment, the same steps as in open surgery are completed with specially designed extended surgical instruments under television surveillance to achieve the same surgical results with less disturbance and damage to the abdominal cavity. Since the retroperitoneal space is an unnatural space, this type of surgery requires better anatomical knowledge and practical experience, and operates on a completely different concept than traditional open surgery. Q: At present, what is the situation of minimally invasive surgery carried out in our urology department? A: In recent years, with the high attention and strong support from the hospital leadership, our urology department keeps up with the trend of medical science and technology, keeps innovating, actively carries out minimally invasive intracavitary surgery and achieves good results, with the success rate of surgery reaching almost 100%. At present, the four major fields of minimally invasive urological surgery at home and abroad include transurethral electrodesiccation of prostate, ureteroscopy, percutaneous nephrolithoscopy and laparoscopic surgery. At present, the Department of Urology of our hospital can carry out minimally invasive techniques for all the above-mentioned urological standing diseases. Among them, transurethral resection of prostate was carried out earlier in China, and ureteroscopy, percutaneous nephrolithoscopy and laparoscopic surgery have reached the advanced level in the province and kept pace with the development in China. The main minimally invasive urological procedures performed in our urology department include: cold knife urethral stricture dissection under direct vision, transurethral electrodesis of prostate, transurethral electrodesis of bladder tumor, ureteroscopy, ureteroscopic holmium laser lithotripsy, percutaneous nephrological holmium laser or pneumatic ballistic lithotripsy, laparoscopic renal cyst decompression, laparoscopic adrenal tumor resection, laparoscopic nephrectomy, laparoscopic ureterotomy and lithotomy. ureterotomy, ureteroplasty (UPJ), laparoscopic radical nephrectomy for renal cancer, and laparoscopic ureteral release and bladder reimplantation, all of which have been successful. Retroperitoneal lymphatic dissection, partial nephrectomy, total cystectomy and radical prostate cancer surgery, which represent the highest difficulty of laparoscopic surgery in urology, are also being carried out. At present, the following minimally invasive urological specialties have been established in our urology department: a. Laparoscopic treatment specialty: mainly for urological laparoscopic treatment surgery. b. Minimally invasive stone treatment specialty: mainly for urological laparoscopic treatment surgery. Minimally invasive treatment of stones: mainly percutaneous nephrolithotomy and ureteroscopic lithotripsy, etc. Specialists in prostate diseases: including prostate hyperplasia, prostatitis, prostate cancer, urodynamic examination, transurethral electrolysis of the prostate, cystoscopy, cold knife incision of urethral strictures, etc. Q: Can you talk specifically about the advantages of urological laparoscopic surgery? A: The advantages of laparoscopic surgery are very obvious, briefly speaking, there are several aspects. First of all, the trauma is very small, only three to four small incisions, postoperative stitches or band-aids can be used, the scar is very small, which is very popular for young people and women who love beauty. Secondly, the procedure is a single incision entry, which minimizes damage to the surrounding tissues and minimal scratching means that there is little chance of post-operative adhesions. Many procedures do not use silk ligation, but instead use electrocoagulation or titanium clips to stop bleeding. Third, the incision is airtight and does not cause significant water evaporation, and the internal environment is stable. Fourth, the number of days of hospitalization is small, some can be discharged in 2-3 days, and can be fully restored to health and work in 7 days, thus greatly reducing the patient’s burden and cost, while the turnover rate of hospital beds is accelerated. For example, after laparoscopic adrenal surgery, patients can be out of bed in 2 days and can be discharged in less than a week. Therefore, laparoscopic surgery is popular among patients and surgeons for its “less damage, less pain, faster recovery, precise efficacy, beautiful incision” and good surgical results with minimal trauma. Of course, minimally invasive urological surgery is not an all-inclusive effort, it is minimally invasive but not minimally risky and costly, and should be treated specifically according to hospital conditions, physicians’ experience and technology, disease conditions and economic conditions.