The use of laparoscopic surgery in urology

  The so-called laparoscopic surgery is to make several small incisions of 5-12 mm in diameter in different parts of the abdomen, through which a camera lens and various special surgical instruments are inserted, and the images of various organs in the abdomen taken by the camera inserted in the abdomen are transmitted to the TV screen, and the surgeon completes the surgery by observing the images and operating outside the body with various surgical instruments. It has the advantages of small surgical trauma, fast postoperative recovery of patients, quick hospitalization, light postoperative pain of patients, small abdominal incision scar, aesthetic appearance, etc. The treatment effect is the same as that of open surgery.  In the early days, laparoscopy was only limited to examination and diagnosis, and in the mid-1980s, laparoscopic surgery began to enter the field of surgery. The first laparoscopic cholecystectomy was performed by Filipi and Mouret in France in animal experiments and clinically, respectively, and in 1988 Dubois demonstrated laparoscopic cholecystectomy and published a paper on it. In urology, the laparoscopic search for intra-abdominal cryptorchidism had already been attempted by Cortesi in 1976, and in 1979 Wickman used the laparoscopic retroperitoneal route for ureterotomy and lithotomy. 1985 Smith performed laparoscopic pelvic ectopic nephrectomy and lithotomy. In 1990, Schuessler reported the first laparoscopic pelvic lymph node dissection in a patient with prostate cancer; in the same year, Clayman explored the organ crushing technique and performed the first laparoscopic nephrectomy; and Sanchez-de-Badajoz proposed laparoscopic high-grade ligation of the spermatic vein. Many useful explorations were made by urologists around the world in various cases. Since then, a new era of urology has begun.  Initially laparoscopic techniques were used for a variety of resective procedures. This included retroperitoneal or pelvic lymph node dissection, high spermatic vein ligation, transabdominal or retroperitoneal access for nephrectomy or adrenalectomy, renal cyst debulking, retroperitoneal lymphocyst drainage, bladder diverticulectomy, orchiectomy, etc. In 1995, Kavoussi and his colleagues performed the first laparoscopic living donor nephrectomy. In the next 5 years, laparoscopic donor nephrectomy has matured. In the 1990s, urologists began to take on the challenge of more difficult reconstructive procedures laparoscopically, with Bloom, Vancaillie, Nezhat, and others achieving success with ureteral implants, pyeloplasty, bladder neck suspension, bladder enlargement, and kidney fixation, among others. In 2000, Guillonneau, Vallancien, and Abbou in France reported laparoscopic radical prostate cancer; in the same year, Gill and colleagues performed laparoscopic total cystoprostatectomy in a patient with invasive bladder cancer, with bilateral pelvic lymph node dissection and ileal bladder replacement.  Laparoscopic technology in urology has developed rapidly and leaps and bounds in China. Our department is one of the first units in China to perform urological laparoscopic surgery, and is now able to perform almost all urological surgeries using laparoscopy, including adrenal surgery, pyeloplasty, partial nephrectomy, radical nephrectomy, radical prostate cancer, inguinal lymphatic dissection, pelvic lymphatic dissection and so on. We were also the first in China to carry out radical bladder cancer surgery and urinary flow diversion, and now we are the first in the country and the international leader in the number of cases and results.  In recent years, based on the brilliant achievements of conventional laparoscopic surgery, our department has successfully carried out single-hole laparoscopic surgery. In other words, through a small incision on the skin of the body, a multi-hole operation channel is placed, and the laparoscope and operating instruments are inserted to perform the surgery, and this technology has been successfully applied to various surgeries in urology. In addition to successfully performing single-port laparoscopic radical kidney cancer treatment, partial nephrectomy, adrenal gland surgery, renal cyst surgery, cryptorchidism descending fixation, high spermatic vein ligation, and radical prostate cancer treatment, we have also successfully applied this technology to radical bladder resection, which is the first of its kind in the world.