Laparoscopic Surgery

Laparoscopic Surgery and Robotic-assisted Laparoscopic Surgery Intranet

• Key-Hole Surgery
• Minimally Invasive Surgery

A brief Introduction to Laparoscopic Surgery:
Many traditional urologic surgical procedures require large incisions with lengthy hospitalization and recovery. Minimally invasive surgery, also often known as laparoscopic or keyhole surgery to patients, has recently been developed in the field of urologic surgery with the advancement of engineering and computer technologies. Using a small telescope with built-in magnification mechanism and a variety of long, thin surgical instruments placed through approximately 3-5 incisions (each of which is usually no larger than a dime in size), the surgeon is able to perform minimally invasive surgery for a variety of urologic diseases and problems. Patients who have undergone these procedures have enjoyed not only the same diagnostic and therapeutic benefits of traditional open surgery but also greatly reduced postoperative pain, shorter hospitalization, faster recovery, and better cosmetic results.

Minimally invasive surgery has been applied to a multitude of benign (non-cancerous) and malignant (cancerous) urologic problems. Furthermore, it has been applied to conditions affecting a variety of urologic organs (including kidney, adrenal gland, ureter, bladder, prostate, lymph nodes).

To learn more about each of the procedures below, please click on the appropriate link:

• For Kidney Cancer: Laparoscopic Radical Nephrectomy, Laparoscopic Partial Nephrectomy
• For Kidney Blockage (Ureteropelvic Junction Obstruction): Laparoscopic Pyeloplasty
• For Kidney Cyst: Laparoscopic Renal Cyst Ablation
• For Ureter Obstruction or Anomaly: Laparoscopic Ureteral Reimplantation / Reconstruction
• For Adrenal Gland Tumor: Laparoscopic Adrenalectomy
• For Prostate Cancer: Robotic-assisted Laparoscopic Radical Prostatectomy
• For Testis Cancer: Laparoscopic Retroperitoneal Lymph Node Dissection (RPLND)

A brief introduction to Robotic-assisted Laparoscopic Surgery:
Recently, robotic technology (Da Vinci Surgical System by Intuitive Surgical) has been used in the field of laparoscopic urologic surgery. The robotic system involved is a complex device that allows the surgeon to perform laparoscopic surgery more easily since conventional laparoscopic surgical skills require far greater amount of time and experience for a surgeon to master.

Robotic surgery has been reported to provide greater dexterity to the surgeon, and the clinical data to date appear to be promising and similar to those of the established conventional open surgery and laparoscopic surgery. The new generation robotic system is currently available at Kaiser Permanente Santa Clara Facility and the robotic laparoscopic surgery is offered to the appropriate patients after thorough evaluation in the Urology Clinic.

The robotic system (Da Vinci System) has 2 main components: (a) the surgical robot with arms manipulating the surgical tools and (b) the surgeon console (where the surgeon sits and controls the robot). The surgical robot typically has 2-3 working arms holding laparoscopic surgical tools and a separate arm for holding the magnifying telescope (laparoscope). These tools and camera are inserted through “key-hole” incisions (approximately 1 cm in size) made in the abdomen. The surgeon is seated at a console that is a short distance away from the operating table (where the patient is positioned), and the surgeon has complete control over the telescope and robotic instrument movement using hand and foot controls.

The robotic system (Da Vinci System) is reliable. Although rarely, robotic system breakdown may occur. In such situation of robotic system failure, if the surgeon is experienced in conventional laparoscopic surgery, he or she will be able to complete the surgery via the existing small puncture incisions. However, if the surgeon lacks such experience in conventional laparoscopic surgery, he or she will need to complete the surgery with a large surgical incision (open surgery), in addition to the existing puncture incisions.

At Kaiser, the robotic system is used to assist laparoscopic radical prostatectomy for prostate cancer. Such procedure is often called “robotic-assisted laparoscopic radical prostatectomy” or “Da Vinci radical prostatectomy.” To learn more about this procedure, please click the following link: Robotic-assisted Laparoscopic Radical Prostatectomy

Minimally invasive surgery may not be an appropriate option to every patient. At Kaiser, individualized evaluation and consultation will be provided to all patients interested in this surgical modality.

For information regarding minimally invasive/laparoscopic surgery at Kaiser, please contact Dr. Thomas Hsu and his Urology Department colleagues at (408) 851-4515.

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