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General Laparoscopic and Robotic Surgery

Overview
Laparoscopic surgery involves minimally invasive surgery that achieves the objectives of traditional surgery, but without large and painful incisions. Access into the abdomen is achieved through small incisions that allow thin instruments to be inserted. Carbon dioxide gas is used to distend the abdomen to provide operating space within the abdomen. The surgeon visualizes the surgery on a high-resolution video monitor and manipulates the instruments from the outside of the abdomen. A variety of laparoscopic instruments have been developed for specialized applications. Laparoscopic surgery is widely utilized for surgery of the kidney, adrenal and the prostate gland. Medical insurance companies cover the vast majority of laparoscopic procedures.

Robotic assistance during laparoscopy is helpful in selected reconstructive operations. The daVinci surgical system uses miniature instruments, three-dimensional vision and facilitates elimination of hand tremor.

The Department of Urology at Indiana University School of Medicine is one of the nation's leading centers of excellence for open and laparoscopic surgeries. Some cancer operations that can be better performed by the open approach are performed by surgeons with vast experience in complex open surgeries.

Advantages
Smaller incisions result in less pain, shorter period of recovery, shorter hospital stay, and early return to work and other normal activities compared to traditional surgery. The scars from this "keyhole surgery" are much smaller and cosmetically superior. Early ambulation and decreased pain after surgery can minimize complications related to the lungs such as pneumonia. Blood loss is usually minimal and blood transfusion is rarely required. Robotic assistance can be beneficial for complex reconstructive procedures.

The image at left shows the male torso scars following a laparoscopic donor nephrectomy surgery. For non-donor nephrectomy surgeries, the scars will be similar except for the scar at the lower line of the abdomin. That scar exists only as an exit point for the removal of the donated kidney and therefore would not be created in other laparoscopic surgeries.

Urologic Surgeries Performed
Kidney Surgery

  • Donor Nephrectomy for Renal Transplantation
  • Radical Nephrectomy for Renal Tumors Less Than 10 cm in Size
  • Radical Nephroureterectomy for Urothelial Cancers
  • Partial Nephrectomy for Small Renal Tumors
  • Pyeloplasty for Obstruction of the Kidney
  • Surgery for Cysts

Adrenal Surgery

  • Adrenal Tumors That Produce Excessive Quantity of Hormones
  • Adrenal Tumors That Grow in Size During Observation

Prostate Surgery

  • Radical Prostatectomy for Localized Prostate Cancer
  • Pelvic Lymph Node Dissection for Staging of Prostate Cancer

Several Other Laparoscopic Operations are Performed in Selected Patients.

Laparoscopic Surgery with Robotic Assistance
Robotic assistance during laparoscopic surgery in urology is particularly beneficial for complex reconstructive surgery, such as radical retropubic prostatectomy (for prostate cancer) and pyeloplasty (for obstruction of the kidney). The robot can help shorten the learning curve among surgeons and can facilitate laparoscopic suturing.

The daVinci Surgical System
The daVinci surgical sytem helps the surgeon with the laparoscope as well as the instruments. The surgeon sits at a console at one end of the operating room and the assistant and nurses are beside the patient. The system uses specialized instruments that work like a miniature hand and can follow the movements of the surgeon's hands. The advantages include viewing of images in 3-D as well as the elimination of hand tremors. images daVinci Surgical System in use (Intuitive Surgical Inc, Sunnyvale, CA)

Below are video files showing in split screen the actions of the daVinci Surgical System with a view of the doctor's fingers operating it.