Endoscopic surgery for urological tumors
In department of urology in this hospital, laparoscopic surgery (Fig. 1) for kidney cancers, renal pelvic/ureteral cancers, adrenal tumors have been introduced from early on. Laparoscopic surgeries are performed with a kind of several tubes, called as trocars inserted under small skin incisions. Laparoscope (camera) and instruments including forceps, scissors, and graspers are inserted through the trocars. Kidneys, ureters, or adrenal glands are dissected from the surrounding tissues and organs in the abdominal cavity and put them into a bag and pulled out through an appropriately extended wound. Generally, the advantages of laparoscopic surgery compared with laparotomy include less bleeding, less post-operative pain, and earlier convalescence. On the other hand, laparoscopic surgery requires unique techniques different from laparotomy because instruments that are straight without any joint at the tip are manipulated under laparoscopy. We perform the laparoscopic surgeries for urological tumors safely with few complications.
Endoscopic surgery for benign urological diseases
Endoscopic surgery for renal or ureteral stones has drastically evolved. In trans-urethral ureterolithotripsy (Fig. 2), cystoscopy is inserted through urethra and subsequently guidewire is inserted into a ureter. Then, ureteroscopy is inserted to ureteral stone as guided by guidewire. Recently, renal or ureteral stones are safely fractured with less operative time by development of excellent flexible ureteroscopy with higher resolution and advancement of a laser device that enables to fragment stones into very small pieces. In cases where it is difficult to fragment stones into small pieces by moving quickly by laser impact, there is a particular setting to minimize stone movement. Furthermore, the particular mode setting allows ureteral stones to be fragmented into dusts, which are discharged spontaneously with the perfusate from the body.
Vesicoureteral reflux is a disease that urine flows backward from bladder to renal pelvis, causing higher probability of pyelonephritis accompanied by high grade fever and sometimes decreased renal function. Standard of care for vesicoureteral reflux includes reimplanting the ureter directly into the bladder with anti-reflux mechanism under laparotomy. Our department has introduced laparoscopic ureteral reimplantation through bladder since 2015 (Fig. 3). It is a minimally invasive surgery with less post-operative pain. In this surgical technique, laparoscope (camera) and tubes, called as trocars are directly inserted into the bladder and the same surgical steps as laparotomy are taken.
