Ideas to ease difficulties in

Laparoscopic Urology

Dr. Anmar Nassir, FRCS(C)

Fellowship in Andrology (U of Ottawa)Fellowship in EndoUrology and Laparoscopy (McMaster Univ)

Chairman, Department of Surgery Umm Al-Qura UnivConsultant Urology, King Faisal Specialist Hospital, Jeddah

Introduction

During the last 25 years, probably urology was the surgical specialty that presented the most extraordinary technological development.Evolution

{ open minimally invasive}.

Development{techniques technology}.

Clayman. From knife to needle to nothing, Braz J Urol 2001Clayman. From knife to needle to nothing, Braz J Urol 2001 Clayman. From knife to needle to nothing, Braz J Urol 2001Clayman. From knife to needle to nothing, Braz J Urol 2001

Introduction

Laparoscopic procedures are continuously evolving in Urology. This includes Ablative procedures:

radical nephrectomy

Reconstructive techniques: pyeloplasty.

Both: radical prostatectomy. radical cystectomy.

Why to accept laparoscopy as an alternative to open

HUYNH, HOLLANDER, J of Urol, February 2005HUYNH, HOLLANDER, J of Urol, February 2005

LAPAROSCOPIC NEPHRECTOMY COMMUNITY HOSPITAL. Michigan, USA

HUYNH, HOLLANDER, J of Urol, February 2005HUYNH, HOLLANDER, J of Urol, February 2005

LAPAROSCOPIC DONOR NEPHRECTOMY COMMUNITY HOSPITAL. Michigan, USA

Raftopoulos et al, Surgical Endoscopy Oct 2004 Raftopoulos et al, Surgical Endoscopy Oct 2004

Raftopoulos et al, Surgical Endoscopy Oct 2004 Raftopoulos et al, Surgical Endoscopy Oct 2004

Raftopoulos et al, Surgical Endoscopy Oct 2004 Raftopoulos et al, Surgical Endoscopy Oct 2004

Recent advances …

In laparoscopic surgery technological improvements.

In imaging technologies

Hemal, Menon. Laparoscopy, robot, telesurgery & Hemal, Menon. Laparoscopy, robot, telesurgery & urology: future perspective. J Postgrad Med 2002urology: future perspective. J Postgrad Med 2002

Hemal, Menon. Laparoscopy, robot, telesurgery & Hemal, Menon. Laparoscopy, robot, telesurgery & urology: future perspective. J Postgrad Med 2002urology: future perspective. J Postgrad Med 2002

Recent advances in laparoscopic surgery technological improvements.

Advances in imaging technologies Urologist acceptance Decrease morbidity Patients interest.

Hemal, Menon. Laparoscopy, robot, telesurgery & Hemal, Menon. Laparoscopy, robot, telesurgery & urology: future perspective. J Postgrad Med 2002urology: future perspective. J Postgrad Med 2002

Hemal, Menon. Laparoscopy, robot, telesurgery & Hemal, Menon. Laparoscopy, robot, telesurgery & urology: future perspective. J Postgrad Med 2002urology: future perspective. J Postgrad Med 2002

RPLND

But..

The major impediment to widespread application of laparoscopy in urology has

been the complexity and technical demands of urological procedures

Bishoff, Kavoussi: Urological Laparoscopy, Why bother? J Urol 1998Bishoff, Kavoussi: Urological Laparoscopy, Why bother? J Urol 1998 Bishoff, Kavoussi: Urological Laparoscopy, Why bother? J Urol 1998Bishoff, Kavoussi: Urological Laparoscopy, Why bother? J Urol 1998

Difficulties In starting While practicing

Patients’ factor Instruments

Toward advancement

How to overcome?

Difficulties In startingWhile practicing

Patients’ factor Instruments

Toward advancement

Longer OR time In preparing or startingVisualization Instruments

Laparoscopic Fenger-plasty.

Atlas of the Uro Clin Oct 2003 Vrabec, Al-Zahrani

Atlas of the Uro Clin Oct 2003 Vrabec, Al-Zahrani