All early stage cancers of the urinary tract can be treated with keyhole surgery. The advantage of laparoscopy over conventional open procedure is less blood loss, operative field magnification, lesser pain and faster recovery.
In this procedure, under General Anaesthesia, 3-4 ports are placed through 5-10 mm holes made on the belly. Gas is inserted in the belly through one of the ports while remaining ports help instruments to be passed inside the abdominal cavity. The camera system is connected to the television screen that helps the surgeon to see precisely inside the abdomen. Then the surgeon with the help of assistant removes the tumor/ organ having tumor depending on the stage of cancer. Finally, the removed specimen is placed inside a bag inserted from one of the ports and taken out through a small incision made on the skin. The postoperative recovery is fast with patient being able to move around next morning and being able to take food orally after 24 hours. The patients are generally discharged on day 3-5 depending on the case severity.
Laparoscopic radical nephrectomy (LRN) is considered the standard treatment for most patients with renal malignancies that are not eligible to nephron-sparing surgery. Major advantages of LRN over open radical nephrectomy include decreased perioperative morbidity, lower blood loss, shorter hospital stay, and quicker convalescence.
In patients with metastatic renal cell carcinoma, the laparoscopic cytoreductive nephrectomy can be performed with low morbidity, smaller blood loss, and shorter hospital stay. The minimally invasive technique may shorten the interval between the nephrectomy and start of systemic therapy.
Laparoscopic Partial nephrectomy for renal cancer was initially indicated for patients with compromised renal function, solitary kidney, and bilateral tumor.
Although laparoscopic approach has become the gold standard for benign surgical adrenal disorders such as Cushing's disease, aldosteronoma, and pheochromocytoma, only few reports addressing laparoscopic surgery for adrenal malignancy are available. Tumor size per se is not a contraindication, although we generally limit laparoscopic adrenalectomy to tumors in the 10 cm range.
Radical cystectomy is the gold-standard treatment for organ confined muscle invasive or high-grade superficial recurrent bladder cancer. Laparoscopic approach for radical cystectomy is relatively new, and studies available in the literature show encouraging perioperative and short-term oncological data. Urinary diversion can be performed either intracorporeally ("pure laparoscopic") or through a 5-7 cm mini-laparotomy incision ("laparoscopic assisted"). When comparing "pure laparoscopic" technique to "laparoscopic-assisted" technique we found that the morbidity of laparoscopic radical cystectomy is largely due to the urinary diversion procedure. Our data support the extracorporeal performance of the bowel work and ureteroileal anastomoses. Laparoscopic-assisted radical cystectomy is technically more efficient, associated with a quicker recovery profile, and decreased complication rate.
Radical prostatectomy has been shown to improve cancer-specific survival in the context of a randomized trial. The laparoscopic approach offers the advantage of magnification of the surgical field, allowing a clear operative field with better view during the dissection of the neuro-vascular bundles and urethro-vesical anastomosis.
Laparoscopic nephroureterectomy with en bloc bladder cuff for upper tract urothelial carcinoma appears to have similar oncological outcomes comparing to open nephroureterectomy, regarding positive margin rate, and bladder, local and distant recurrences. Operative time and perioperative complication rate are equivalent, with less blood loss, less analgesic use, and shorter hospitalization, avoiding the usual two incisions of the open nephroureterectomy.
When indicated, standardized retroperitoneal lymph node dissection (RPLND) can be performed for Stage I and low-volume Stage II disease using laparoscopic access, even after chemotherapy. Both staging and therapeutic techniques are currently performed with minimal morbidity. RPLND after chemotherapy represents a technical challenge. The complication rate for this procedure is still high, and it should be performed by only very experienced laparoscopic surgeons.