Minimally Invasive Surgery | In Depth
What are the types of minimally invasive surgery?
Laparoscopy
Laparoscopy is the most common MIS procedure for major operations on the kidney and bladder. It may be performed from the front of the body, the side, or the back, depending upon the operation needed and the surgeon's preferences.
Operations most commonly performed using these techniques include:
- diagnostic operations for testicles in the abdomen
- orchiopexy (bringing a testis from the abdomen)
- nephrectomy (removing the kidney)
- partial nephrectomy (removing part of the kidney)
- pyeloplasty (correction of kidney obstruction near the kidney)
- removal of kidney cysts
- removal of some kinds of stones
- removal of the ureter along with the kidney, if it is also diseased
- bladder surgery, particularly for vesicoureteral reflux
Robotic surgery
Laparoscopy may also be performed with the assistance of a surgical robotic system. This system is performed in a similar way as laparoscopy with small punctures in the abdomen to place instruments with a lighted telescope to see the operation. The instruments, however, are controlled by the surgeon working through a complex computer that permits the movements to be more natural, smooth, and delicate.
The surgeon is able to see the operation with a three-dimensional image, while sitting at a console manipulating the instruments in the patient. The surgeon is in control at all times; the robot simply makes the movements more precise and smooth. This has permitted surgeons to perform very delicate reconstructive operations even in very small children, that would have otherwise been very difficult using conventional laparoscopy.
Laser surgery
Many people ask about "laser" surgery, which is simply the use of laser power for some form of surgery. It may be confused for laparoscopic surgery. Lasers are used to break stones when used in an endourological procedure such as ureteroscopy. They may also be used to cauterize blood vessels in special cases within the urinary tract.
What are the advantages of MIS?
The advantages of MIS include very small scars, which are difficult to see after several months, less pain after surgery, and usually a shorter hospital stay. In younger children this advantage is less noticeable because young children recover easier from even major surgery. In school-age and adolescent children, however, the difference is very noticeable. In many cases children can go home in one to two days instead of three to four days. They will be able to return to their normal activities more quickly as well. This will depend upon the particular operation, but even after a kidney operation it can be possible to be back to normal activity in seven days instead of two or three weeks.
Are there any disadvantages to MIS?
There are relatively few disadvantages to MIS methods as long as the surgeon is experienced in them. More surgeons are being trained in these methods and it is becoming a routine part of training in many centers. In rare cases, the operation will not be able to be finished laparoscopically, due to unusual anatomy, bleeding, or complications from the procedure. In these cases the operation will nearly always be finished by traditional methods of "open" surgery with an incision.
However, there are many procedures which MIS is not appropriate for. Technical limitations of MIS equipment -- such as lack of dexterity of the tools -- make it unsuitable for many pediatric procedures.
The overall safety of MIS techniques appears to be equivalent to open surgery in both children and adults. As with all surgery, the experience of the surgeon and the center where it is being performed is very important to the outcome of the operation.
