Minimally invasive laparoscopic surgery, also known as “keyhole” surgery or perforation surgery, involves making several small holes of 0.5-1 cm in the patient’s abdominal wall and using instruments instead of the surgeon’s hands to enter the abdominal cavity to complete the surgery through the laparoscope and the TV screen display. Laparoscopic surgery is a new surgical technique, which places instruments into the abdominal cavity through tiny incisions in the abdomen and examines, diagnoses and treats diseases in the abdominal cavity through a TV screen, with little trauma to the patient’s body, little interference, little pain and quick recovery. It has changed the history of extensive abdominal wall incision and surgical method to explore the abdominal cavity, which has challenged the traditional surgery.
What are the advantages of laparoscopic surgery compared to traditional open surgery?
1) Laparoscopic surgery does not need to open the abdomen, and the abdominal wall is less traumatic because the incision is made through the muscle slit into the abdominal cavity without destroying the muscle layer, so there is mostly no postoperative incisional pain, and generally no pain treatment is needed. The chance of bleeding, infection and splitting of the incision after surgery is very small.
2) Internal trauma is slight, and the laparoscopic image can be magnified 8-10 times, so small blood vessels and nerves can be seen clearly and are not easily mistakenly injured, and there is little intraoperative bleeding and almost no postoperative abdominal exudate.
3) The hospital stay after laparoscopic surgery is significantly shortened, generally 2-3 days after surgery can be discharged, and 3-5 days can resume normal life.
4) Laparoscopic surgery is performed in vivo, in a completely closed state, so the chance of causing abdominal infection is much smaller than that of open surgery, and the postoperative antibiotic time is also short, so the side effects caused by the application of antibiotics are also reduced.
5) The gastrointestinal function of the patient recovers quickly after laparoscopic surgery. They can resume eating and get out of bed the day after surgery, which effectively reduces the amount and time of postoperative infusion. It prevents postoperative intestinal adhesions, intestinal obstruction and pulmonary infection, deep vein thrombosis, urinary retention and other complications.
6) Good postoperative abdominal cosmetic effect of laparoscopic surgery. The size of the abdominal wall incision is usually 0.5-1.0 cm and is scattered with 2-4, and the post-healing scars are very small.
7) Laparoscopic surgery displays the whole procedure on a TV screen through an electronic video recording system, which can be observed by all members of the operation and the disease and the surgical method can be discussed at any time.
What diseases can be treated by urological laparoscopic surgery?
Broadly speaking, all diseases of organs that can be reached through the abdominal cavity can be operated on laparoscopically.
Adrenal surgery The adrenal gland is located in the fatty capsule above the kidney and is relatively hidden. Laparoscopic resection of adrenal tumors is the gold standard for the treatment of this disease, including: adrenal cortical adenoma, pheochromocytoma, dermal medullary hyperplasia, medullary lipoma and other adrenal tumors.
2. Renal surgery
Simple nephrectomy: including polycystic kidney/transplanted kidney/hydronephrosis/end-stage kidney/tuberculous kidney/congenital malformation;
Radical nephrectomy for renal cancer, partial nephrectomy
Renal pelvic dissection and lithotomy
Renal prolapse – renal fixation
Renal cyst/ polycystic kidney decortication
Hydronephrosis – pyeloplasty
3. Ureteral surgery
Ureterotomy and lithotripsy
Ureteral tumor resection
4. Bladder surgery
Bladder rupture repair
Ureteral bladder implantation
Total bladder ileal cystectomy
5.Prostate surgery
Radical prostate cancer surgery
6.Male surgery
Varicocele ligation
Exploration of high cryptorchid, which can be resected and descending fixed
Traffic duct ligation for traffic syringomyelia
Spermatocystectomy
7. Hernia repair
Are there any contraindications to laparoscopic surgery?
Patients with the following conditions are not suitable for laparoscopic surgery.
Poor cardiopulmonary function, especially in patients with poor pulmonary function, who cannot tolerate general anesthesia for major reasons.
Those with a history of previous surgery at the surgical site and estimated heavy abdominal adhesions
Those who are overly obese
Those with coagulation disorders
What are the results of laparoscopic surgery? Is it complete?
Some patients have concerns that laparoscopic surgery is not as intuitive and reliable as open surgery, but it is not. The laparoscopic image is magnified 5-7 times, and the surgeon operates as if under a magnifying glass, so the possibility of side injuries is very low.
Can laparoscopic surgery be performed on a patient who has been operated on before?
For example, most of the open surgeries for kidney and ureter are performed via retroperitoneum, and the abdominal cavity is not adherent, so laparoscopic surgery can be considered if the surgery has been performed for more than two years: in addition, laparoscopic treatment of recurrent hernia has no effect on laparoscopic surgery because the surgical route has changed.
Can laparoscopic surgery be performed in obese patients?
Compared to open surgery, ordinary obese patients are more suitable for laparoscopic surgery because open surgery in obese patients is prone to complications such as liquefaction of the incision, infection and incisional hernia, while laparoscopic surgery can avoid these complications, except for overly obese patients, who are difficult to operate regardless of the type of surgery.
Can multiple diseases be treated in one operation?
The laparoscope has a large intra-abdominal observation area, and patients with concurrent general, obstetrical and gynecological diseases can be treated by laparoscopic surgery at the same time. For example, gallbladder removal with hernia repair, ovarian cyst removal, etc.
Is the cost of laparoscopic surgery high?
In general, laparoscopic surgery is 200-500 RMB more expensive than open surgery, but the total cost of hospitalization is comparable. For small and medium-sized laparoscopic surgery, the total cost is lower because the number of postoperative hospitalization days is less, and the patient can be discharged in one or two days; for larger and complex laparoscopic surgery, the total cost is higher than open surgery because of the increased cost of special instruments and consumables.
Can you give some specific cases to illustrate the advantages of laparoscopic surgery?
The advantages of laparoscopic surgery over open surgery are obvious, let’s give two examples:
Cryptorchid release and fixation: 1 The spermatic cord is released into degree and the difference is obvious. The former is sufficient, and some high cryptorchid can also be handled, and there is no retraction after loosening and fixing, and no need for traction after surgery, which reduces the pain of postoperative traction.2 The incision is small and hidden, which can protect the patient’s privacy.3 Postoperative recovery is fast, and heals in 1-3 days. In contrast, open surgery is prone to incomplete pulling down, testicular retraction, and traction for two weeks after surgery, increasing pain, obvious scarring of the incision, and painful postoperative incision and traction pain. The main thing is that high cryptorchid cannot be detected and treated (mostly diagnosed as anorchidism).
Ureteral lithotomy: Larger ureteral stones that cannot be treated by extracorporeal lithotripsy or ballistic lithotripsy can be removed laparoscopically or openly, especially for upper ureteral stones, the incision of open surgery is about 15cm, and because many muscle layers are cut off, the postoperative incision pain is obvious and recovery is slow, and it takes 7-10 days to be discharged, while laparoscopic surgery only requires two 1.0cm and one 0.5cm small holes. The postoperative period is painless and the patient can be discharged in 1-3 days, which is a significant difference.
Is there a single procedure for urological laparoscopy?
Some patients are aware of the single-patient payment policy for some diseases implemented in our province this year. Urological laparoscopic surgery for high spermatic vein ligation is a single-patient procedure with a lump-sum cost of RMB 3,550.
Can pediatric and elderly patients undergo laparoscopic surgery?
Age is not a contraindication to laparoscopic surgery, and laparoscopic surgery can be performed on children and the elderly. We did cryptorchidism release and fixation on a two-year-old child, who recovered well and was discharged from the hospital in two days after surgery; for the elderly who have no abnormal heart and lung function, laparoscopic surgery is safer than open surgery.