Laparoscopy: what it is and how it is applied to urology

Since the last years of the 20th century, there have been great advances in surgical techniques. Thanks to them, nowadays few patients need the conventional use of the scalpel for their intervention, something that was indispensable in conventional “open surgery”.

We are experiencing a boom in the so-called “minimally invasive surgeries”, which provide great advantages to patients by allowing them to perform the same operations as in open surgery but avoiding large incisions.

With laparoscopic surgery it is sufficient to make small incisions of half a centimeter or 1 cm, through which a high-resolution camera and tiny instruments are introduced to perform the operation from inside the abdomen. The surgeon and his team control the operation in great detail through a high-definition screen.

This is not only a great advantage in terms of the patient’s well-being, because the smaller the wounds, the less postoperative pain he/she will feel and the sooner he/she will be able to return to normal life, but it will also cause less blood loss. This reduces the need for transfusions; and in expert hands can even improve the precision of the operation, by introducing a camera that provides a clear and magnified image of distant organs, with details that the naked eye does not see.

Laparoscopy in urology

In urological diseases, when it is necessary to operate on a kidney or bladder tumor, or to completely remove the prostate in the presence of a malignant tumor, open surgery is gradually being replaced by laparoscopic surgery. In fact, today it is common for a patient operated on for prostate cancer by laparoscopy to be discharged from the hospital the day after the operation, with much less discomfort and hardly any postoperative bleeding.

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The surgery of the future

In this regard, the latest advance is robotic surgery. It consists of an evolution of laparoscopy, in which the camera and instruments are not handled directly by the surgeon’s hands, but by the arms of a robot. This robot is controlled by the specialist through the controls of a console, and allows him to perform much more comfortable and delicate movements, without tremors, and with three-dimensional images of the inside of the patient’s abdomen.

The most commonly used procedure is robotic prostatectomy, which preserves the erector nerves and thus avoids the frequent sequelae of impotence that appear after open prostate surgery. Its main disadvantage, which has limited its use, is its current high cost compared to conventional laparoscopy.

Undoubtedly this will be the future of surgery, but we can say that “the future has already begun”.