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.
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
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 surgeonís
hands ever entering the patientís abdomen.
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.
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 surgeonís exact movements as directed by finger and
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.