Most Advanced Laparoscopic Pyeloplasty at World Best Hospitals in India

               Laparoscopic Pyeloplasty in India

Pyeloplasty is common surgery in women to relieve urinary blockage in the area known as the uretero-pelvic junction (UPJ), where the pelvis and ureter tube meet. Normally urine forms in the kidney and flows into the area of the pelvis. Basically, pyeloplasty is the surgical reconstruction or revision of the renal pelvis (kidney) to drain and decompress the kidney. Several procedures have been developed over the years to treat this condition but pyeloplasty gives the highest chance of cure. The evidence to date suggests that laparoscopic pyeloplasty has an even higher success rate than traditional surgery.

                             Types of Pyeloplasty

Open Pyeloplasty : Pyeloplasty is an operation to repair a block in the ureter as it exits the kidney. It can be performed using either an open surgical approach or ‘keyhole’ (laparoscopic/robotic) surgery, and the type of surgery will depend on a number of factors, that will be discussed with you. There are other options, such as endopyelotomy, which may be considered in some circumstances. The specific reason you need an open pyeloplasty will be discussed with you.

Laparoscopic Pyeloplasty : Laparoscopic Pyeloplasty provides patients with a safe and effective way to perform reconstructive surgery of a narrowing or scarring where the ureter (the tube that drains urine from the kidney to the bladder) attaches to the kidney through a minimally invasive procedure. This operation is used to correct a blockage or narrowing of the ureter where it leaves the kidney. 

Robotic Assisted Pyeloplasty: Robotic-assisted pyeloplasty is performed under general anaesthetic. This keyhole method uses 3 to 4 small cuts, through which a camera and surgical instruments can be passed. The camera sends pictures to a TV screen so the surgeon can see the kidney and surrounding tissue. It is very similar to laparoscopic surgery, the difference is that the surgeon controls the instruments from a console away from the operating table. 

Percutaneous Antegrade Endopyelotomy : In this an incision is made directly over the region of upper pole of kidney. The nephroscope is inserted through the incision upto the renal pelvis and narrowed area. Micro instruments are then guided through the scope with the help of a camera and the narrowed portion is cut. The ureter and the pelvis are stitched up and a stent is positioned from the pelvis up to the bladder. 

• Retrograde Endopyelotomy : The procedure is same as above except that instead of a nephroscope, a ureteroscope is used which is inserted through the bladder and guided up to the renal pelvis. The narrowed part is removed and the stent is place from the bladder to the pelvis. This procedure can be performed in an outpatient setting.

Why do I need a laparoscopic pyeloplasty ?

Your surgeon will have explained that your urine is not draining from the kidney properly because of a narrowing at the pelviureteric junction (PUJ). This may be causing you pain. He has chosen this method of surgery to reduce the length of your recovery and to allow you to resume a normal life in a shorter period of time when compared to the more conventional open method of repairing the narrowing.

Best Treatment Options for Enlarged Prostate in India

Enlarged Prostate :

Laser Surgery for Enlarged Prostate

Green Light Laser PVP :Green Light Laser PVP (Photoselective Vaporization of the Prostate) is minimally invasive technique in the treatment of the enlarged prostate. It uses high-powered laser light combined with fiber optics to vaporize the overgrowth of prostate cells.

In this procedure the surgeon directs the laser at the prostate; the intense pulses of light emitted from the fiber are absorbed by the blood. Within moments, the temperature of the blood becomes so fine it causes the nearby cells to vaporize.

There is growing interest in this procedure by patients and as well as by the surgeons because of its simplicity and effectiveness. A temporary catheter is often inserted to allow urine to drain from the bladder. The procedure takes near about one hour.

The benefits of Laser Technique are really unmatched: 

• No Cut so Less Pain
• No Bleeding.
• There is no need of blood transfusion.
• Early return to normal activity and work.
• Patient is able to urinate better with a good stream.
• Complications occur less frequently and are mild if they do.
  

Surgical Treatment for Enlarged Prostate

1. Radical Prostatectomy :

In radical prostatectomy the surgeon removes all of the prostate gland and some of the tissue around it. It is done to treat prostate cancer. The techniques of radical prostatectomy surgery includes:

• Retropubic Technique: When the incision is made in the lower belly, it is called the Retropubic approach.
• Perineal Technique: When the incision is made in the perineum (between the anus and the scrotum) it is called the Perineal approach.

2. Laparoscopic Prostatectomy :

The prostate can be removed using keyhole (laparoscopic) surgery. The surgeon uses a thin tube with a video camera (laparoscope) inside the cuts which allows the surgeon to see inside the belly during the procedure. The video camera gives a magnified view of the prostate gland on a video screen. The surgeon cuts away the prostate gland from the surrounding tissues. The major difference with this surgery is that the surgeon makes several small cuts instead of one big cut.

3. Robotic Prostatectomy :

The world’s most advanced robotic prostatectomy surgery available is the da Vinci Surgical System. Robotic prostatectomy is becoming more popular as it is less painful and minimally invasive prostate cancer treatment. The da Vinci robotic prostatectomy enables surgeons to overcome many limitations of both open prostatectomy and laparoscopic prostatectomy.

The da Vinci surgical console consists of high-resolution cameras and micro-surgical instruments that enable the surgeon to perform robotic prostatectomy by controlling the device powered by robotic technology. During robotic prostate surgery the da Vinci robot provides the surgeon with improved visualization and precision compared with open or laparoscopic surgery. This allows the surgeons to perform fine computer-controlled movements and a more precise and minimally invasive robotic prostatectomy. It achieves the same or better prostate cancer treatment results than a surgeon’s own hands in open or laparoscopic surgery.

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Advantages of Laparoscopic and Robotic Surgery for Prostate Cancer:

1. Less Scaring: its minimally invasive. Instead of having a 5 or 6” incision to the skin and abdominal fascia, patients have a series of small “band-aid” incisions.
2. A Shorter Hospital Stay: With smaller incisions, the postoperative pain is significantly less, which means your length of hospitalization is shorter.
3. Less Drugs, Minimal Blood Loss:
   Patients’ need for postoperative pain medicine and narcotics is also greatly reduced after the laparoscopic/robotic approach compared to open surgery. During Robotic or laparoscopic prostatectomy, blood loss is very minimal and has a negligible risk of needing a transfusion.
4. Reduced risk of Erectile Function: Robotic prostatectomy’s ability to preserve the erectile nerves. During an open prostatectomy through an incision on the anterior abdominal wall, the nerves that provide erection are hidden behind the prostate. The approach taken using the surgical robot, enters the abdomen and the robotic arms are positioned posterior to the prostate with the nerves directly in front of the robotic/laparoscopic camera. In this way, the nerves maybe preserved, primarily because the anatomy can be seen more clearly compared to open 

Laser Prostate Surgery Hospital in India - TURP

Minimally Invasive Laser Prostate Surgery in India

What is Transurethral Resection of Prostate ?

Transurethral Resection of Prostate or T.U.R.-Prostate or T.U.R.P. is a treatment of choice if the enlarged prostate gland compresses on the urethra resulting in obstruction of urinary outflow. In the TURP, the glandular tissue is removed in small chips or pieces as opposed to Radical Prostatectomy where the prostate gland is removed in it's entirety. T.U.R.P. is an endoscopic procedure where the prostate gland can be visualized while it is being resected.

Prostatic surgery or Prostatectomy comprises other form of surgery such as Suprapubic prostatectomy, Transurethral resection of the prostate(TURP), Open prostatectomy, Laser prostatectomy, Transurethral needle ablation,(TUNA). On the basis of the size of the prostate gland, different kind of prostatic procedures are decided. TURP is performed on the glands bigger than 30 grams and less than 80 grams. But if the prostate gland is bigger than 90 grams, open prostatectomy is performed. Prostatic surgery is not performed on the patients having bood clotting disorder or bladder disease (neurogenic bladder).

• Irregular or absent periods

• Hormone imbalance

• Smoking or alcohol use

• Endometriosis

• Fibroids

• History of infertility

Minimally Invasive Laser Prostate (TURP) Surgery in India

Laser Prostatectomy

Laser prostatectomy or Laser for prostatic surgery is recently developed minimally invasive treatment modalities for patients having BPH i.e benign prostatic hyperplasia or benign prostatic hypertrophy. The term Benign prostatic hyperplasia or benign prostatic hypertrophy means increase in size of the prostate gland in the men above 50 years of age. Laser Prostatectomy is used mainly to remove the prostate gland when there is no cancer in it but its size enlarges due to which it creates problem in the urinary tract. Laser prostatectomy is a short and easy procedure, usually after which the patient can return to their home on the day of operation itself.

• Procedure for laser prostatic Surgery

Patients who has a history of BPH are recommended by their doctors to undergo laser prostatic surgery as because they cannot be treated by the medical therapy. Before the surgery the patients has to undergo several preoperative measurements like American Urologic Association symptom score, Uroflowmetry, Prostate-specific antigen and Transrectalultrasonography (TRUS). Laser prostatectomy uses beams of light to destroy prostate tissue. It is mainly done under the use of regional anesthesia. This laser beam helps in destroying any prostate tissue which blocks the opening of the urethra and bladder outlet. After the laser prostatic surgery, the rate of urine flow improves and reduces the symptoms of BPH. A Foley catheter may be placed in the patient body after the surgery to help in emptying the bladder. For few days after the surgery catheter usually remains in place.

Types of Minimally Invasive Laser Prostate (TURP) Surgery in India

Greenlight Laser Treatment For Benign Prostatic Hyperplasia

The GreenLight Laser treatment therapy is the most effective, novel and advanced technique for the treatment of an enlarged prostate, which is clinically referred to as Benign Prostratic Hyperplasia (BPH).The treatment involves a laser beam therapy which evaporates the enlarged prostatic tissue that presses on the outlet of the urinary bladder causing urinary outflow obstruction symptoms. The procedure involves the use of a high powered system (80-120 watts), which generates laser beams, which vaporizes the extra prostatic tissue. This is unlike other procedures like Transurethral Resection of the Prostate (TURP), which use electrical current to burn the tissue, and also puts the surrounding structures at risk of being burnt and destroyed.

The procedure is also referred to as Laser Ablation of the prostate or Photo-selective vaporization of the prostate (PVP) or photo vaporization of the prostate. This procedure has a greater efficacy (compared to other laser treatments like interstitial laser therapy-Indigo and Holmium laser therapy-Lumenis) with fewer side- effects, complications and risks.

Conventional vs Laser Prostatectomy / TURP:

The Laser TURP procedure is much more advanced & beneficial than the conventional procedure. The differences in the two are:

• For the conventional TURP, the resectoscope, a combined visual and surgical instrument is used, whereas the Laser procedure involves use of advanced laser energy to cut excess gland, thus there is no loss of blood & shorter hospitalization is required

• Blood thinning agents have to be stopped a week to 10 days before the procedure for conventional TURP, which puts the heart at risk, whereas the laser TURP is done with the blood thinning agents on board, which is highly beneficial for cardiac patients.

• Conventional TURP allows tissue removal at only 1gram/min, whereas laser can vaporize tissue as fast as 3-4 grams/ min.

• For prostates larger than 100gm, open surgery is required in case of conventional TURP, whereas lasers can effectively perform surgery in such large prostate cases

Advantages of Laser TURP:

1. Safer & Faster

2. No blood loss

3. Shorter hospital stay & faster recovery

4. Highly beneficial for

o Patients on blood thinning agents like heparin, aspirin, clopidegrol etc.

o Patients with kidney dysfunction

o Patients whose prostate gland size more than 60 gm

o Patients whose prostate gland size more than 60 gm

o Patients who are at poor risk for anesthesia

o Patients with cardiac complications or who have undergone joint replacement surgery

Laser TURP in India

People from different parts of the world, especially countries like Nigeria, Kenya, Ethiopia, Uganda, Tanzania, and Western countries, come down to India to consult with reputed urologists. Our hospitals are staffed with physicians trained in reputed medical universities abroad, and are equipped with the most modern diagnostic and surgical equipment.

We are associated with some of the best urologists in the country who can perform Laser TURP at state-of-the-art hospitals using advanced Diode lasers. Another advantage of getting the procedure done in India is the cost aspect. Laser TURP in India will cost only a fraction of what you would have to pay elsewhere.