'Key hole' or laparoscopic surgery is a form of minimally invasive treatment and has been around for several decades. It is much less invasive than conventional/traditional open surgery. Its utilisation in surgery reduces the overall recovery period for the patient: The incision is significantly smaller and more cosmetically acceptable; pain is less; reduced blood loss and hospital stay; convalescence period is shorter. Consequently patients return to normal activities much faster. In the early days it was utilised by Gynaecologists. Subsequent to this, it became accepted by general surgeons for performing operations such as cholecystectomy (removal of the gall bladder)and is continuously being developed in more major general surgical procedures.
Uroogical surgeons have now converted several open procedures into accepted laparoscopic operations some of which can be performed robotically. Some examples are:
(1) Impalpable testis/es
(3) Kidney operations (Nephrectomy/Pyeloplasty)
(4) Urinary tract stone disease
(5) Radical prostatectomy for prostate cancer
(6) Adrenal surgery
Image: Smaller and more cosmetically acceptable scars on the LHS with laparoscopic surgery as opposed to larger and more painful scars as seen with open surgery (RHS)
Image: Illustration of the surgical technique in correcting the obstructed kidney
Uretero-pelvic junction obstruction (UPJO) is a narrowing at the junction of the kidney with the tube (the ureter). The ureter drains urine from the kidney into the bladder. UPJO can cause urinary tract infection, pain and sometimes kidney damage. It is for these reasons that it should be treated.
The gold standard surgical procedure is open pyeloplasty which results in a scar anything from 15 - 22 centimetres long. The obstructing area is removed and the two ends are then brought back together. The success rate is high (over 90%) but this procedure is invasive resulting in pain. Coupled with the resulting trauma to the body, recovery is slow and return to full and normal activities delayed (6 -12 weeks). You would typically remain in hospital following the operation for 7-10 days. It is for these reasons that many investigators/clinicians have sought after less invasive forms of treatment as highlighted below.
NEWER FORMS OF MINIMALLY INVASIVE TREATMENT
This is an endoscopic/telescopic procedure and therefore no cuts are made on the outside of the body. A balloon is guided up from the bladder and across the narrowed area which is subsequently stretched open. The mean success rate is approximately 75% but this is short lived.
Again as above a telescope is guided either directly into the kidney via a small skin incision or through the bladder utilising a guide wire as with balloon dilatation. The success rate is similar to balloon dilatation and likewise short lived.
The first laparoscopic pyeloplasty was first performed in 1993. The success rate is as with the gold-standard open and more invasive technique (see above).
The first part of the operation is the endoscopic placement of a small internal tubing across the area of narrowing. It is removed under a local anaesthetic approximately 3 weeks after surgery. The operation is performed through 4 small (0.5 1.0 cms) cuts near the lower rib. In some cases, however, difficulties may be encountered during the procedure and a conversion to open conventional operation is necessary (4% ).
Back on the ward
Any discomfort after the operation is easily controlled by the pain-killers. You would have a cathether draining your bladder and a drip to ensure that you are well hydrated until you are able to take oral liquids (usually overnight). The average hospital stay is 2-4 days after the procedure.
On discharge from hospital
You should not undertake strenuous physical exercise. You may not drive for up to two weeks after the operation.
The renogram which originally confirmed your diagnosis will be performed at 3 months. All being satisfactory, this will be repeated annually.
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