Minimally invasive techniques are gaining ground

In the field of urology, recent years have also seen increasing application of minimally invasive surgical techniques as a standard. Endoscopic interventions for diseases of the adrenal gland, kidney, ureter, bladder and prostate constitute routine surgical procedures today. Conventional open surgical techniques, however, continue to be justified for the treatment of large tumours or in cases where tumours have grown into large blood vessels.

The spectrum of surgeries which are generally suited for laparoscopic interventions include:

• Prostatectomy
• Pyelotomy
• Nephrectomy
• Ureteral anastomosis

Especially in recent years, endoscopic nephrectomy or partial nephrectomy has developed into a standard procedure in urologic surgery. The “keyhole technique” which visually magnifies the operating field and allows the handling of particularly fine instruments, is precise and gentle.

Prostatectomy techniques
The actual breakthrough in laparoscopy for urologic surgery took place about 15 years ago in form of the standardised laparoscopic radical prostatectomy. Prostate cancer is one of most common cancers in men.  In Germany, the risk of developing prostate cancer that requires treatment is approximately 16 per cent. Prostatectomy can be performed as a

• Perineal
• Retropubic
• Laparoscopic

procedure.  

Retropubic prostatectomy is currently the most common procedure worldwide. During this open surgical procedure, the prostate is dissected beyond the peritoneum between the symphysis and the navel. The anastomosis between bladder stump and urethra can be created under direct visual control.

In comparison to the retropubic surgical method, the laparoscopic prostatectomy is a difficult surgical intervention which requires more time. This minimally invasive procedure provides the patient and the health care sector with a number of benefits:

• Minimal damage to neurovascular structures due to optimum visibility of the operating field
• Minimal bleeding in the operating field
• Early continence
• Reduced rate of morbidity
• Conserving of blood transfusions
• Shorter hospital stays
• Faster convalescence

Laparoscopic ultrasonic instruments: safe coagulation and cutting
The use of ultrasonic instruments in laparoscopy leads to even more precise and faster results with even less haemorrhaging. Ultrasound can be used for tissue dissection and coagulation at a frequency range of 55 kHz, since the walls of the blood vessels adhere to one another and thereby lead to occlusion. This effect is very selective and enables a precise procedure during dissection and coagulation.

Advantages of the Söring ultrasonic instruments:

• Less haemorrhaging and therefore improved view of the operating site for the surgeon
• No visible formation of smoke
• Low-risk dissection and coagulation since there is no current flowing through the patient 
• Ergonomic handling
• Cost efficiency through reusability

Methoden