Application of laparoscopic surgery in urology: An experience with 509 cases / 第二军医大学学报

ABSTRACT

The last ten years have witnessed a rapid development in laparoscopic surgery for urology, but there are still many specific problems need to be discussed concerning the operation procedures. From October 1998 to August 2006, 509 patients have received laparoscopic surgery in our department. Our experience is summarized as following (1) Compared with the peritoneal approach, the retroperitoneal approach is faster in exposing the operative field and more experience from the open operation could be used, so retroperitoneal approach should be recommended unless for a few difficult cases or cases need to be treated bilaterally. (2) In radical nephrectomy, the kidney should be completely removed including the lymph nodes. Open operation should be considered if the diameter of the tumor is more than 10 cm. Adrenal gland resection should not be considered unless the tumor locates in the upper pole. In radical resection of the renal pelvic carcinoma, attention must be paid to prevent tumor metastasis into the ureter. The kidney vessels must be separated in the nephrectomy operation and the use of hemo-lock is recommended to block the kidney artery. (3) Laparoscopy is a golden standard for adrenalectomy; the operation procedure should be chosen according to the property, location, involvement, and blood supply of the tumors. (4) Whether to use laparoscopic surgery or not for patients warranting difficult surgeries such as radical prostatectomy should be decided considering the general condition of the patients and the skills of the surgeons. As for operations for varicocele, we do not recommend laparoscopic surgery because it can be readily treated with open operation.