Minimally invasive surgical procedures are performed at Johns Hopkins to treat the most complex disorders of the urinary tract less invasively and more effectively. For patients, minimally invasive surgery means potentially less pain, a shorter hospital stay, and faster recovery.

Laparoscopy

Pioneering laparoscopic research and innovative surgical techniques carried out at Johns Hopkins in the 1990s have helped define the use of laparoscopy as opposed to traditional open surgery, leading to an alternative form of treatment. Laparoscopy has revolutionized treatment options for patients requiring urologic surgery.

Laparoscopy (from the Greek words lapara, or flank, and skopion, a means of viewing something) is a type of surgical procedure in which small (1-2 cm) incisions are made and plastic tubes (trocars) inserted through them to keep the channel open so that tools--including surgical instruments and the viewing telescope (laparoscope) with its mini-camera--can be inserted. When the abdomen is inflated with carbon dioxide, organs can be pushed out of the way for access and better vision, allowing the surgeon to work while watching an external video monitor. The tools can be manipulated to make necessary repairs, just as if the abdomen had been cut open the oldfashioned way, but without the surgeon’s hands ever entering the patient’s abdomen.

Li-Ming Su, M.D., Director of Laparoscopic and Robotic Urological Surgery at Johns Hopkins, and Christian P. Pavlovich, M.D., Director of Urological Oncology at Johns Hopkins Bayview Medical Center, use minimally invasive techniques for treating many urological conditions. Laparoscopic partial nephrectomy is now used to manage kidney tumors less than 3 cm in size, allowing the cancer to be removed while leaving the remainder of the healthy, uninvolved kidney in place. Hospital stay is usually less than three days. Within two weeks, many patients are ready to return to regular activities.

Laparoscopy is also used for radical cystectomy with urinary diversion for patients with bladder cancer. In addition, surgeons also use laparoscopy to freeze renal tumors (laparoscopic cryoablation), repair ureteropelvic junction obstructions (laparoscopic pyeloplasty), excise renal cysts, and perform renal biopsies (laparoscopic renal biopsy). In the pediatric urology division, surgeons regularly use laparoscopic techniques for undescended testicle cases (laparoscopic orchidopexy).

The laparoscopic radical prostatectomy program at Johns Hopkins was initiated in 2001 to remove cancerous prostate glands. Since then, more than 500 successful procedures have been performed initially by Dr. Su and Dr. Pavlovich. Our surgeons routinely perform six to eight laparoscopic prostatectomies per week through five 1-centimeter "keyhole" incisions (each about the size of a dime) made across the mid-abdomen. Small laparoscopic instruments are used to precisely dissect the prostate gland, seminal vesicles, and vasa deferentia from the urethra and bladder. Although the procedure is performed laparoscopically, the surgery adheres to the same anatomic principals of open surgery perfected by Dr. Patrick C. Walsh, but without the surgeon's hands ever entering the patient's body. Blood loss during laparoscopic prostatectomy is routinely less than 300 cc, and transfusions are rarely required. Patients typically go home two days after surgery and can return to regular activities within two weeks.

Robot-Assisted Surgery

The robotic-assisted radical prostatectomy and robotic technology will only get better and more sophisticated.

Technology has long been a part of medicine, and prostate surgery is another example of how technology is making possible medical procedures that could not have existed without computers and robotics. The introduction of the da Vinci robot (Intuitive Surgical Corporation of Sunnyvale, California) has taken the radical prostatectomy to a new dimension. Johns Hopkins currently has two robots in use. For the radical prostatectomy, six tubes are placed in the abdomen so the robotic arms and other laparoscopic tools can be placed inside. The surgeon sits at the computer console about 10 feet from the operating table, looking into a special screen that provides 12 X magnification, and manipulates the 18-inch robotic arms, which carry out the surgeon’s exact movements as directed by finger and foot controls.

Finger controls on the da Vinci robot
precisely control movements of the special
surgical tools within the body.

The robot-assisted radical prostatectomy and robotic technology will only get better and more sophisticated with more surgeons using this technology in the future. Both Dr. Su and Dr. Pavlovich are teaching a new generation of young doctors to perform minimally invasive surgery with the same quality and adherence to maximizing cancer cure while improving quality of life for their patients.