Minimally Invasive Procedures
A minimally invasive procedure is any procedure (surgical or otherwise) that is less invasive than open surgery used for the same purpose. A minimally invasive procedure typically involves use of laparoscopic devices and remote-control manipulation of instruments with indirect observation of the surgical field through an endoscope or similar device, and are carried out through the skin or through a body cavity or anatomical opening. This may result in shorter hospital stays, or allow outpatient treatment. However, the safety and effectiveness of each procedure must be demonstrated with randomized controlled trials.
A minimally invasive procedure is different from a non-invasive procedure, such as external imaging instead of exploratory surgery. When there is minimal damage of biological tissues at the point of entrance of instrument(s), the procedure is called minimally invasive.
Minimally Invasive Procedures
Minimally invasive procedures performed at Dr. Plawner’s office include:
ESWL: extracorporeal shock wave lithotrypsy, for crushing urinary stones, is done using a special technology that generates shock waves that crush the stone placed in focal point of the waves. There is no bodily invasion; the stone fragments are eliminated with the patient’s urine. Stones up to 2 cm in diameter can be treated that way.
PCNL: For larger stones it is preferable to undergo direct stone access (contact) Lithotrypsy. This method prevents dissemination of stone fragments all over the kidney. It is done in steps: first by gaining access to the kidney by puncture under local anesthesia and then dilating the access tract under general anesthesia in the Operating Room. After creating an access accommodating a nephroscope the stone is crushed under visual control and the fragments vacuumed out through the instrument. (Swiss Lithoclast).
Ureteroscopy and Lithotrypsy: this technology permits removal of stones impacted in the ureter, the tube that connects the bladder to the kidney. If the stone is small and not embedded in the lining (mucosa) it can be caught in a basket. Otherwise it can be crushed with a laser and the fragments will be eliminated with patient’s urine. All this is done under general anesthesia in the Operating Room.
Benefits of Minimally Invasive Robotic Surgery
As with other minimally invasive procedures, patients who undergo minimally invasive robotic surgery benefit in several ways: the procedure is less painfull, they don’t lose as much blood, the incision is smaller and less visible, they spend less time in the hospital are back to their normal activities faster. Most important of all, there are studies that demonstrate that they may have better clinical outcomes.
The advent of Robotic Surgery changed the landscape of Urologic Surgery. It was easier to learn the steps especially for Surgeons with extensive experience with open surgery. Intuitive Surgical, the inventor of Da Vinci Robot, gave a great support to train and help to incorporate this technology into every day practice.
The advantages of this type of surgery are great, most of the patients leave the hospital the next day, and there is a minimal blood loss and a speedy, minimally painful recovery. There is the preservation of continence and sexual function in prostatectomy patients. There are excellent results in terms of cancer free margins and cancer free life to follow.
For more information, contact Dr. Plawner by calling (212) 737-2330 for a consultation.