FROM THE 15TH INTERNATIONAL CONGRESS AND ENDO EXPO
LAPAROSCOPY UPDATE: UROLOGY COMMITTEE
HOWARD N. WINFIELD, MD
Since 1990, urologic surgeons have taken a leading role in minimally invasive surgery (MIS). Laparoscopic radical nephrectomy, first described in 1991, is now considered the “gold standard” for localized renal tumors. Laparoscopic partial nephrectomy for renal masses ≤ 4 cm is gaining increasing popularity. However, this procedure continues to present significant challenges requiring laparoscopic suture repair of the surgical defect, hilar control of renal vessels to minimize hemorrhage and concern for warm ischemic damage to the remaining renal parenchyma. Renal cooling and hemostatic techniques are in evolution to overcome these obstacles. Encouraging long term results (>5 years) are maturing to demonstrate the effectiveness of laparoscopic cryoablation and radiofrequency ablation for the treatment of small renal masses. Laparoscopic radical prostatectomy is more popular in Europe, and radical cystectomy is performed in select centers in the United States with promising results.
Robotic surgery has found major applications in the field of Urology. Radical prostatectomy (RRP) is the most frequently performed robotic procedure, outstripping all other surgical disciplines. In 2002 there were only 600 robotic prostatectomies performed whereas in 2004 there were 9600 cases reported. This exponential growth is expected to continue. Oncologic effectiveness, urinary continence, and erectile function are very comparable with open surgery. The blood loss and convalescence appear to be superior with robotic RRP. Robotic-assisted pyeloplasty for ureteropelvic junction has gained popularity with excellent results comparable to open or laparoscopic pyeloplasty. Robotic radical cystectomy is performed in select centers with encouraging results.
Urologists continue to play an active role for surgical training in the form of computer virtual reality simulation, validity testing and core programs in minimally invasive surgery for residents. Improved methods to provide continuing medical education in minimally invasive surgery for urologists has become an important focus of the American Urological Association.
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