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The
ability to carry out operations using the keyhole methods
has fascinated surgeons for decades. In the 90’s keyhole surgery
for kidney cancer became established.
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Laparoscopic procedures offer many
options for both the physician and the patient. Compared
with traditional surgery, laparoscopic procedures offer
the following advantages:
- Smaller incisions resulting in
reduced pain and discomfort
- Minimal scarring
- Greater surgical precision
- Enhanced visualization of the
surgical site
- Less trauma
- Fewer complications
- Less blood loss and a decreased
need for blood transfusions
- Reduced risk of infection
- Shorter hospital stays
- Faster recoveries
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These procedures require
intense training and special skill, best results are obtained
by surgeons who specialise in and perform a number of procedures.
I started performing keyhole surgery using
the traditional pure laparoscopic technique but soon realised
the additional advantages of "hand assisted laparoscopy"
HAL for treating kidney cancer.
 Hand
Assisted Laparoscopy HAL
This involves using an innovative device
called "hand port" which allows the surgeon to insert
one hand inside the abdomen while carrying out the laparoscopic
procedure. The operating time is shorter; surgeon has tactile
feedback and uses the hand port to remove the kidney at the
end of the procedure. The scar and recovery time are same
as conventional laparoscopy procedure.
This technique has allowed me to remove
large and complicated kidney tumours, would normally require
an open operation, laparoscopically.
I am using this technique for nephro-ureterectomy-
removal of kidney and ureter in cases of transitional cell
cancer of kidney and ureter and in selected cases requiring
partial nephrectomy- removal of a part of kidney
Scar
following a right HAL kidney removal
Prostate Cancer
 Keyhole
surgery for prostate cancer was first demonstrated in 1995
but only became accepted in 2000. It is still performed
by a few specially trained urologists in UK. This
procedure is rapidly gaining popularity and will be the way
forward for this kind of surgery. This technique combines
the advantages of retropubic prostatectomy with better vision
for the surgeon and reduced blood loss, hospitalisation, catheterisation
time and recovery. This procedure requires great technical
skill and takes longer than an open operation.
 Most
patients will stay in hospital for two days and will resume
normal activity within two to three weeks.
I believe for selected patients this technique
will have great benefits, however not all patients are suitable
for this type of surgery
Scars after a laparoscopic
radical prostatectomy
 Bladder
Cancer
I am using the "hand assisted"
technique of keyhole surgery to remove the bladder in patients
with muscle invasive bladder cancer. I believe that keyhole
surgery will be the way forward in bladder cancer patients
who are usually elderly and unfit. Rapid recovery and lower
complication rates make this approach very attractive. It
is once again a very skilled procedure and a very few surgeons
offer this to their patients
Scar and stoma after laparoscopic
cystectomy
All patients offered laparoscopic surgery
have to understand that in case of any difficulty in carrying
out the procedure laparoscopically
I will convert to an open procedure
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