Laparoscopic urology at Warwickshire Hospital

Laparoscopic urology is keyhole surgery for conditions affecting your kidneys, bladder, prostate or other urinary organs, done through a few small cuts instead of one large incision. A thin tube with a camera and long, narrow instruments let your surgeon carry out the same operation as open surgery, with less trauma to your body.

What conditions does it treat?

• Kidney cancer or other kidney tumours
• Kidney stones
• Severe kidney injury, long-term kidney infection, polycystic kidney disease, or a shrunken or poorly working kidney
• Swelling of the kidney caused by a blocked flow of urine, including a blockage where the ureter joins the kidney, which can be present from birth, caused by scarring from previous surgery, a blood vessel pressing on the area, or a stone stuck in the ureter
• Conditions affecting the adrenal gland, ureter, bladder or prostate, including prostate cancer
• Undescended testicles and varicose veins around the testicle (varicocele).

What are the benefits of laparoscopic urology?

• The same diagnostic and treatment benefits as open surgery
• Less pain after the operation
• A shorter stay in hospital
• Faster recovery
• Better cosmetic results, since the cuts are much smaller: a kidney, for example, can be removed through 3 punctures of around 5 to 12mm each, compared with a cut of more than 10 to 15cm for open surgery
• Fewer complications overall than open surgery.

Are there different approaches?

Laparoscopic urology covers a wide range of specific operations, and the technique can also vary in how the instruments are controlled.

• Simple nephrectomy: removing one kidney.
• Radical nephrectomy: removing a kidney together with the nearby adrenal gland and lymph nodes.
• Partial nephrectomy: removing only the affected part of the kidney.
• Nephroureterectomy: removing the kidney and ureter together.
• Pyeloplasty: relieving a blockage between the kidney and ureter.
• Removing the testicle, correcting an undescended testicle, or treating varicose veins around the testicle.
• Removing lymph nodes, or draining a fluid collection (lymphocele).
• Radical prostatectomy: removing the prostate for prostate cancer.

Some of these operations, particularly prostate removal, are increasingly carried out with robotic assistance, where the surgeon controls the instruments through a robotic system rather than holding them directly.

What happens during the procedure?

1. Your surgeon makes 3 to 5 small cuts in your abdomen, none normally bigger than a coin.
2. A laparoscope, a narrow tube carrying a camera and light source, is passed through one of the cuts, sending a magnified image to a screen in the operating theatre.
3. Long, thin surgical instruments are passed through the other cuts to carry out the operation, whether that's removing tissue, freeing a blockage, or another urological procedure.
4. For some operations, particularly prostate removal, your surgeon may control the instruments through a surgical robot instead of holding them directly, which can improve visualisation and precision.

What are the risks and complications?

• Infection or blood loss.
• Rarely, injury to nearby organs, such as the bowel, lung, major blood vessels, spleen, liver, pancreas or gallbladder.
• The operation occasionally needing to be converted to standard open surgery if difficulty is encountered part-way through.
• For kidney removal: injury to nearby structures, reduced function in a remaining kidney, or a temporary drop in kidney function, along with a small risk of a hernia at one of the cut sites.
• For partial kidney removal: the same risks as above, plus a small risk of urine leaking from the treated area.
• For relieving a kidney blockage (pyeloplasty): infection, blood loss, the operation not fully relieving the blockage, or injury to nearby tissue or organs.