What is laparoscopic surgery?
Laparoscopic surgery is the method popularly known as “keyhole surgery”. The operation is performed with a thin camera (laparoscope) and special long instruments inserted through usually 3–5 small openings, 0.5–1.2 cm in diameter, in the abdominal wall. The camera image is shown magnified on a screen, and the surgeon performs the operation while watching this image.
Carbon dioxide gas is introduced into the abdominal cavity to create a working space. In some kidney and adrenal operations, the surgeon proceeds through the space around the kidney at the back (retroperitoneal approach) without entering the abdominal cavity. The route chosen depends on the organ, the disease and the patient’s anatomy.
An important point: what changes in laparoscopy is the route by which the organ is reached. The procedure performed on the organ – the actual operation, such as removing a tumour or repairing a narrowing – follows the same principles as in open surgery.
The difference between laparoscopy and endoscopic surgery
Because the term “closed surgery” can be used for two different methods in urology, patients often confuse the two approaches:
- Endoscopic surgery: Procedures performed with thin cameras passed through the urinary tract (the urinary opening) without any skin incision. Laser kidney stone surgery (RIRS), ureteroscopic stone surgery (URS), endoscopic prostate surgery and transurethral resection of bladder tumours (TURBT) belong to this group.
- Laparoscopic surgery: A method in which the surgeon enters through small openings in the abdomen or flank and works on the outer surface of the organ. It is used when an organ needs to be removed completely or partly, or repaired.
Which approach is suitable for a condition depends on the type and location of the disease. For example, a small kidney stone is usually treated endoscopically, whereas laparoscopic surgery is considered for kidney tumours.
General advantages of laparoscopy
Compared with open surgery, the laparoscopic method is generally associated with the following:
- Smaller incisions and smaller scars
- Less pain after surgery and less need for painkillers
- A shorter hospital stay
- An earlier return to daily life
- A lower risk of incisional hernia and wound infection
- The ability to work in detail in narrow spaces thanks to the magnified image
These advantages do not apply to the same extent in every patient. Recovery time depends on the type of operation, the extent of the disease and the person’s general health.
Urological operations that can be performed laparoscopically
The following operations can be performed laparoscopically in suitable patients. Details of each can be found on the relevant page.
Kidney operations
- Radical nephrectomy: Removal of the kidney together with its surrounding fatty tissue for kidney tumours.
- Partial nephrectomy: For kidney tumours of suitable size and location, removal of only the part containing the tumour, preserving healthy kidney tissue.
- Simple nephrectomy: Removal of kidneys that have lost their function and cause symptoms or infection.
For diagnosis and treatment options for kidney tumours, see the kidney cancer page.
Adrenal gland operations
Laparoscopic adrenalectomy is the method frequently chosen for adrenal masses that produce hormones or need to be removed because of their size. For details, see the adrenal tumours page.
Narrowing of the renal pelvis (pyeloplasty)
For a narrowing at the point where the renal pelvis joins the ureter, the narrowed section is removed and the two parts are rejoined. Details can be found on the UPJ obstruction and pyeloplasty page.
Prostate and bladder operations
- Radical prostatectomy: Removal of the prostate and seminal vesicles for organ-confined prostate cancer. For details, see the prostate cancer page.
- Radical cystectomy: For bladder tumours that have invaded the muscle layer, it can be performed laparoscopically in selected patients. See bladder cancer.
Stone operations
Today, the vast majority of kidney stones are treated with endoscopic methods such as RIRS, URS and PCNL. However, for large single stones in the renal pelvis, large ureteral stones or anatomical variations, laparoscopic pyelolithotomy or ureterolithotomy may be an option in selected patients. In ectopic or unusually positioned kidneys, laparoscopy can also be used to assist PCNL. For general information, see the kidney stone treatment page.
Varicocelectomy
In an enlargement of the testicular veins (varicocele), the veins can be tied off laparoscopically. Microsurgical methods are also widely used for varicocele; which method is suitable varies from person to person. For details, see the varicocele page.
Single-incision (navel) laparoscopy
In single-incision laparoscopic surgery, several instruments are used together through a single entry point placed in the navel instead of several openings. The scar remains largely inside the navel. This method is technically more demanding and is mostly preferred for selected, relatively simple operations and in patients with a suitable body build. If needed, additional small openings can be made during the operation.
Who is not suitable for laparoscopy?
Laparoscopy is not suitable for every patient and every condition. In the following situations, open surgery or another method may be safer:
- Heart or lung disease severe enough that the patient cannot tolerate gas being introduced into the abdomen
- An uncontrolled bleeding disorder
- Extensive adhesions inside the abdomen from previous operations
- Very large tumours or tumours that have spread to surrounding organs
The choice of method is made individually after the examination and imaging results have been assessed.
The possibility of conversion to open surgery
In an operation started laparoscopically, conversion to open surgery is possible in situations such as bleeding, unexpected adhesions or anatomy that does not allow safe working. This decision is made for the patient’s safety and should not be regarded as a failure. This possibility is discussed with the patient before the operation and is included in the consent form.
Preparation before surgery and recovery
Before surgery, blood tests, any necessary imaging and an anaesthetic assessment are carried out. Blood thinners are adjusted or stopped a certain time beforehand on the doctor’s advice. Laparoscopic urological operations are performed under general anaesthesia.
After surgery:
- Patients are usually helped out of bed on the day of surgery or the next day; walking early reduces the risk of blood clots and helps the bowels to start working.
- Fluids and soft foods are usually started within a short time.
- Shoulder pain caused by the gas introduced into the abdomen may last a few days.
- The hospital stay varies with the type of operation; for most operations it is a few days.
- A return to desk work is often possible within a few weeks; a longer wait is recommended before heavy lifting and strenuous exercise.
When should you seek help after discharge?
If any of the following develop during recovery at home, consult a doctor without delay:
- A temperature above 38 °C or chills
- Increasing abdominal pain, marked swelling of the abdomen, persistent nausea or vomiting
- Redness, discharge or bleeding from the port sites
- One-sided swelling and pain in a leg, or sudden shortness of breath
- Inability to pass urine or heavy blood in the urine
Risks
Laparoscopic surgery is still an operation and carries most of the risks of open surgery: bleeding, infection, injury to neighbouring organs (bowel, blood vessels), deep vein thrombosis and anaesthetic risks. In addition, a hernia at the port sites, gas escaping under the skin and temporary shoulder pain may occur. The risks specific to each operation are covered in detail on the relevant treatment pages and during the consultation.
Laparoscopic urologic surgery in Bursa, Turkey
Op. Dr. Mücahit Kabar graduated from Uludağ University Faculty of Medicine and completed his urology residency at the Urology Clinic of Ankara Training and Research Hospital. He has published scientific studies on laparoscopy-assisted percutaneous nephrolithotomy, radical nephrectomy series and renal masses. In Bursa (Nilüfer), at Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00) and Özel Jimer Hastanesi (weekdays 13:00–17:00), he assesses laparoscopic surgical options for kidney, adrenal, prostate and urinary tract conditions together with the patient after examination.
Consultations are held in English or Turkish. The hospitals’ international patient departments can arrange interpreters for other languages and help with airport transfers and accommodation. If you are travelling from abroad, you can book your appointment in advance through the online booking page or appointment line of Özel Medicabil Nilüfer Hastanesi (weekdays 08:30–12:00, +90 444 8 112) or Özel Jimer Hastanesi (weekdays 13:00–17:00, +90 444 45 67). You can share your imaging and test results in advance via WhatsApp (+90 541 622 54 82). More information is available on the international patients page and the contact page.
