Laparoscopy has represented an evolution in the field of urological surgery. This technique has meant an improvement in the quality of life of patients, by reducing the discomfort and complications of large incisions. It is also an advantage for urologists who can visualize more precisely the anatomical structures of the “target” organs, due to the magnification of the image offered by the lenses, cameras and monitors available today.
As in other surgical specialties, laparoscopy is very widespread, being used in different areas of urological surgery. Laparoscopic surgery is less invasive for the patient than conventional surgery. In addition, this technique reduces incision-related morbidity, decreases bleeding and blood transfusion rates, and shortens hospital stays and convalescence.
Laparoscopic surgery has been applied in various subspecialties of urology. In the field of reconstructive urology: repair of ureteral strictures, exeresis of large benign obstructive prostates. Bladder enlargements with bowel, bladder and rectal prolapse corrections, etc. In patients with renal lithiasis, laparoscopy can minimize complications of open sky approaches or can be combined with endoscopic procedures through natural or minimally invasive orifices, for example to free some renal cavities of stones. In patients with renal failure and transplant, laparoscopic surgery can be an alternative to solve the problems derived from polycystic kidney disease, ureteral complications of transplantation and has been a procedure that has improved living renal donation because it minimizes the trauma that a nephrectomy for transplantation represents for the donor.
But it is in uro-oncologic surgery where laparoscopy is mostly used, due to its prevalence. The removal of the prostate secondary to cancer (radical prostatectomy) is one of the most widely used laparoscopic surgeries in our environment, and the writer has extensive experience with more than 700 procedures performed since 2002. The rates of continence, potency and oncologic results obtained are similar to those obtained by open surgery in expert hands, but minimizing bleeding and incision.
The removal of the urinary bladder due to urothelial cancer can benefit from this type of approach, which can reduce the rate of digestive complications and the early recovery of intestinal transit after reconstruction of the digestive system by constructing the urinary diversion. In the field of nephrectomy (kidney exeresis), laparoscopy is currently the procedure recommended in all clinical guides. The improvement in techniques and surgical experience has made it possible to remove part of the kidney by laparoscopic surgery, a complex procedure but one that allows the patient to retain a higher percentage of renal function after excision of the malignant renal tumor.