Minimally Invasive Surgery
Urological Surgery
Minimally invasive procedures are now available to diagnose and treat many types of urological problems, including prostate and kidney cancer, stones, and other genitourinary problems. All of these procedures results in much less pain than traditional surgery, dramatically reducing the need for strong pain medications and the drowsiness, fatigue, and unsteadiness that accompany these medications. Patients can return to their normal activities in a fraction of the time that would be necessary with traditional surgery.
In laparoscopic surgery, a small telescope is inserted into the abdomen through a small incision (cut). The surgeon repairs the problem by inserting tiny surgical instruments through other small abdominal incisions. Laparoscopy is done using general anesthesia, sometimes as an outpatient procedure and sometimes with an overnight hospital stay.
Cooper was the first hospital in South Jersey—and one of just a few in the region—that has the daVinci® Surgical System, a laparoscopic surgical robot that combines computer technology and the surgeon’s skill. The surgeon makes three small incisions in the patient, and inserts the robotic arms (two for surgical instruments and the third for a tiny video camera). He/she performs the procedure while seated as a computer console, where the camera transmits a 3-dimensional magnified image of the patient’s insides. Urologic procedures performed with the daVinci® Surgical System require general anesthesia and a hospital stay.
Extracorporeal shock wave lithotripsy (ESWL)uses x-rays and/or ultrasound to produce high energy shock waves outside of the body, which cause kidney or ureteral stones to break into tiny pieces which pass easily in the urine.
Ureteroscopy is used to destroy, remove, or repair ureter stones, tumors, and strictures. The ureterscope, a telescope-like instrument, allows the surgeon to see and access the ureter stone, tumor, or stricture.
Minimally invasive urological surgery isn’t right for every patient. Before any surgery, the Cooper surgeon will discuss the procedure, including whether to use a minimally invasive or traditional procedure, with the patient in detail. The key to a successful outcome is selecting the right procedure to meet the individual patient's needs.
For more information on Minimally Invasive Surgery options available at Cooper University Hospital or to schedule an appointment with a Cooper physician, please call our referral and information line at 1-800-8-COOPER (800-826-6737).
Laparoscopic Procedures
Laparoscopic Adrenalectomy
Tumors growing on the adrenal glands, and one or both adrenal glands can cause production of excess hormones and may need to be removed surgically. Also, large adrenal masses may need to be removed if cancer is suspected. Cooper surgeons routinely use laraposcopy for this procedure. Traditional surgery may be necessary, however, to remove adrenal glands that are very large or produce volatile hormones.
Hand-Assisted Laparoscopy
In hand-assisted laparoscopy (HAL), used in various urological procedures, a Cooper surgeon uses a special sleeve to insert his hand into the body through a small incision (cut). HAL provides improved control and sensation and enables the surgeon perform certain advanced laparoscopic procedures more quickly and safely than with standard laparoscopic techniques. Surgeons can remove affected organs intact through the same small incision made to insert the hand; this allows the sample to be more accurate evaluated, especially when cancer is suspected. One of the most common conditions treated with this approach is kidney cancer.
Laparoscopic Surgery of the Kidney
Laparoscopic Nephrectomy
Kidney removal (nephrectomy) may be necessary in patients with kidney cancer, recurrent kidney infection, severe stone disease, or long-term obstruction of the kidney. Also, a kidney may be removed from a healthy donor for transplantation into a patient with kidney disease. Cooper surgeons use a variety of laraposcopic techniques to remove a kidney. Laparoscopy enables surgeons to see the kidney better during surgery and results in a much smaller scar—about 3”—than traditional surgery, which requires a 10-20” scar and, sometimes, the removal of a rib.
Laparoscopic Partial Nephrectomy
Currently, when kidney cancer is often diagnosed before it is of a large size or spreads to other parts of the body, in the majority of patients, removing the part of the kidney with the tumor is all that is needed (partial nephrectomy.) The technique for partial nephrectomy is similar to complete removal of the kidney; however, additional reconstruction is needed to repair the damaged tissue and to restore kidney function. Cooper surgeons use advanced laparoscopic techniques to perform this procedure. Laparoscopy enables surgeons to see the kidneys better during surgery and results in a much smaller scar—about 3”—than traditional surgery, which requires a 10-20” scar and, in some cases, the removal of a rib.
Laparoscopic Nephroureterectomy
Transitional cell carcinoma is a type of cancer that can occur in the renal pelvis and/or the ureter. Surgical removal of the kidney and the ureter (nephroureterectomy) may be necessary if cancer has formed in the lining of these structures or in cases where there is a long history of reflux within the kidney, or if the kidney is non-functioning. Cooper surgeons use laraposcopy to remove the kidney and ureter, resulting in a much smaller scar—about 3”—than traditional surgery, which requires a larger incision or sometimes two.
Laparoscopic Pyleoplasty
Obstructions can occur where the kidney and ureter meet (called ureteral pelvic junction obstruction), due to stone disease, infection, or trauma, or they may be present from birth (congenital). Some people with a ureteral pelvic junction obstruction have no symptoms; others have pain, an infection, or blood in the urine. Ureteral pelvic junction obstruction can cause urine to build up in the renal pelvis, which could damage the kidney. Cooper surgeons use laparoscopic pyleoplasty to repair the ureteral pelvic junction obstruction surgically by removing the obstruction from the ureter and reconstructing the ureter and renal pelvis to improve urine drainage.
Laparoscopic Removal of Renal Cysts
While most kidney cysts are non-cancerous (benign) and require no treatment, some cysts grow large enough to cause pain, obstruct the kidney, or cause high blood pressure. Kidney cysts that produce serious symptoms need to be drained and removed. Cooper surgeons use laraposcopy to remove kidney cysts.
Laparoscopic Surgery for Prostate Cancer
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Raul O. Parra, MD, FACS discusses the benefits of using the the daVinci® Surgical System for Robotic Radical Prostatectomy |
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Laparoscopic Lymph Node RemovalThis procedure is used to determine if
prostate cancer has spread (metastasized) to the
lymph nodes in the pelvis. Patients with a significantly elevated prostate-specific antigen (PSA) blood test, a high tumor grading (Gleason score), and/or disease on both sides of the prostate (bilateral) are more likely to have cancer that has spread to the pelvic lymph nodes. Since treatment options are different for patients with metastatic prostate cancer, determining if the cancer has reached the pelvic lymph nodes before surgery or radiation therapy is very important. Cooper surgeons use
laraposcopy to take a sample of the lymph nodes for analysis, in patients at risk for lymph node metastasis.
Robotic Radical Prostatectomy
The preferred treatment for early stage prostate cancer is the removal of the entire prostate gland (radical prostatectomy). Cooper surgeons can use robotic-assisted laparoscopy (the daVinci® Surgical System) to remove the prostate. Robotic-assisted laparoscopy is done through three small incisions, which is an advantage over conventional surgery, which requires a large abdominal incision. This modern surgical tool provides 3D magnified visualization of tissues which allows the preservation of nerves and other important structures. This results in less side effects to the patient.
Percutaneous Renal Surgery
Stones can form in the kidney and cause pain or an infection. Cooper surgeons use percutaneous kidney surgery on large, complex, or infectious stones and sometimes for transitional cell carcinoma of the kidney. During percutaneous renal surgery the surgeon uses x-ray to guide a needle into the patient’s back and kidney. He then places a special scope (nephroscope) and instruments into the kidney to evaluate and repair the defect.
Shock-Wave Lithotripsy
Although very small kidney stones may pass through the body with little pain, a larger stone can get stuck in the kidney or ureter and cause severe pain. Extracorporeal shock wave lithotripsy is the standard treatment for small to moderate stones without infection or blockage. The procedure does not require any instromentation and is usually done as an outpatient procedure.
Ureteroscopy
Ureteral stones can form in the kidney and get lodged in the ureter, where they can block the flow of urine and cause pain or an infection. Narrowings or strictures can also form in the ureter as a result of previous surgery, radiation therapy, or passage of stones, or be present from birth (congenital). Cancer within the lining of the urinary system, known as transitional cell carcinoma, can also occur within the ureter. Cooper surgeons use ureteroscopy to evaluate, remove and treat ureteral stones, strictures, or tumors without an incision.
Doctors Who Perform These Procedures