If the thought of going under the knife fills you with fear, be reassured. No longer is surgery a brutal and hazardous experience. Thanks to wonders such as laparoscopy, mini endoscopes, flexible endoscopes and state-of-the-art thulium and holmium lasers, surgical intervention is getting safer with time. I have performed more than 2,500 endoscopic and laparoscopic surgeries in the past eight years at Institute of Kidney Disease (IKDRC), Ahmedabad, and Sir Ganga Ram Hospital, Delhi, from 2009 to 2016. I believe these technology innovations proved to be a boon for patients in recent times. There is less blood loss, minimal pain and a short hospital stay.
Mini and flexible endoscopes for kidney stone surgery:
Urinary stone disease prevalence is on the increase with change in dietary habits of the population. While conventional rigid endoscopy can be used to treat a majority of stone cases, some areas of the urinary tract need flexible scopes to approach the stones. The pneumatic lithoclast (stone fragmenter) cannot be used through the flexible scopes. Laser can be transmitted through optical fibres and, therefore, can be used through the flexible scope to break up stones in relatively inaccessible locations.
200 watt thulium laser for prostate surgery:
Prostate enlargement is one of the commonest problems dealt by urologists in middle-aged and older individuals. Distressing symptoms like thinning of the urinary stream, interruption of urination, and increased frequency of urination, especially at night, force these individuals to seek urological intervention.
Prostate enlargement, not responding to medical treatment, needs surgery. A 200 watt thulium laser has a cutting edge over conventional endoscopic removal. Laser technology provides for less bleed, shorter hospital stay and, therefore, is more convenient to the patient, especially heart patients receiving concomitant ‘blood-thinning’ medicines. Large glands can be enucleated endoscopically (ThuLEP), thereby avoiding open surgery.
Laparoscopic surgery for kidney problems:
In laparoscopic or 'keyhole' surgery, narrow telescope and instruments are inserted through small incisions (~1cm) allowing surgery to be performed with less scarring and lower risk of infection. At Choithram Hospital, Indore, which has a 200 watt thulium laser system from Italy, I have been routinely doing laparoscopic kidney surgery for kidney cancers, removal of failed kidney because of stones, infection, laparoscopic correction for block in kidney tubes (lap pyeloplasty), and laparoscopic donor nephrectomy for kidney transplant.
The writer is consultant endoscopic and laparoscopic urosurgeon at Choithram Hospital, Indore.
