Minimally invasive urological surgery
When is this procedure indicated?
Minimally invasive urological surgery is widely used in clinical practice every day, so much that it is now the standard for most operations. Patient selection and choice of surgery type occurs at the time of the urologic visit based on characteristics and pathology. In each case, a team of urologists and anesthesiologists performs a pre-operative evaluation to determine any clinical conditions that would expose the patient to an excessive risk of complications due to the minimally invasive technique. In case of important cardiovascular or respiratory diseases or in some cases of severe glaucoma, minimally invasive urological surgery is not recommended.
How is it performed?
The minimally invasive surgery in urology uses a cavity present in the human being, the peritoneum, which duly inflated with carbon dioxide allows, through laparoscopic and robotic instruments, an optimal visualization of abdominal and pelvic organs. During laparoscopic surgery, the surgeon uses special instruments and moves around while looking at a monitor. During robotic surgery, the surgeon is able to have 3D vision and move around using a surgical console, joysticks and a dedicated viewer. The magnification provided by robotic and laparoscopic instrumentation allows a precision of the surgical act that is not possible to obtain in classical open techniques.
Recovery after minimally invasive surgery is highly dependent on the type of pathology the patient is suffering with, and, therefore, the type of surgery. The following are the recovery periods by procedure:
- Robot-assisted radical prostatectomy: hospitalization lasts on average 2 days, with a bladder catheter stay of about 7 days, and a recovery time to normal physical activity of about 30 days.
- Robotic-assisted radical cystectomy: hospitalization lasts on average 10 days, with a recovery that varies greatly depending on the type of urinary tract and the clinical conditions of the patient, usually you a patient can return to pre-operative habits in about 4 weeks - 3 months.
- Robotic-assisted kidney surgery: hospitalization lasts on average 3 days, with a rapid recovery from discharge, which usually occurs after removal of the bladder catheter.
- Robotic pyeloplasty: hospitalization lasts on average 4 days, with a rapid recovery already from discharge.
The main complications of minimally invasive surgery are infections of the surgical site, which occur in about 5% of cases and in most cases resolve with antibiotic therapy alone, followed by complications due to the removal of lymph nodes and complications due to immobilization, which occur in less than 1% of cases.
Long-term complications are related to the pathology for which surgery was performed. In particular, in prostate surgery, the recovery of continence and sexual potency are very variable and depend on the aggressiveness of the tumor and whether or not the noble structures responsible for erection and continence have been preserved. In renal surgery, depending on the extent of tumor removal (radical nephrectomy or partial nephrectomy), the main long-term consequence is renal failure, which is in all cases managed by a team of experienced nephrologists at the disposal of the Urology operating unit. In minimally invasive surgery for bladder cancer, complications depend largely on the type of urinary diversion decided upon (incontinent vs continent), and are largely overlapping with the long-term effects of minimally invasive prostate surgery.