Urology
Adrenalectomy
A Minimally Invasive Approach to Kidney Donation
Female Urinary Incontinence
A Minimally Invasive Approach to Kidney Removal
A Minimally Invasive Approach to Kidney Tumors
A Minimally Invasive Approach to Prostate Cancer
A Minimally Invasive Approach to Cancer of the Renal Pelvis and Ureter
Adrenalectomy
The adrenal glands, which include the adrenal cortex and medulla, are located on top of the kidneys. The adrenal cortex is the outer and bigger part of the adrenal gland. It produces hormones, including glucocorticoids (cortisol) and mineralocorticoids (aldosterone), which control the body's metabolic process. Without cortisol or aldosterone the body is not able to respond adequately under minimal physical or emotional stress, including change in temperature, exercise, or excitement.
The adrenal medulla, the inner portion of the adrenal gland, secretes the stimulants epinephrine and norepinephrine. Pheochromocytoma, a tumor of the adrenal medulla, causes excessive amounts of these stimulants to be released, resulting in hypertension. Pheochromocytoma is most common in young people. Only a small percentage of the lesions is malignant.
When an adrenal tumor or malignancy is present, an adrenalectomy (removal of one or both adrenal glands) is performed to reduce excessive secretions of adrenal hormones. If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic adrenalectomy is appropriate for you.
How is laparoscopic adrenalectomy performed?
An adrenalectomy is the removal of one adrenal gland (unilateral adrenalectomy), the removal of both adrenal glands (bilateral adrenalectomy), or partial removal of one or both adrenal glands. Laparoscopic adrenalectomy uses a thin, telescope-like instrument called a laparoscope, which is inserted through a small incision in the flank (fleshy area between the ribs and hip). The laparoscope is connected to a tiny video camera – smaller than a dime – which projects a view of the operative site onto video monitors located in the operating room. The abdomen is inflated with carbon dioxide, a gas, to allow your surgeon a better view of the operative area. Two or three additional small incisions are made near the laparoscope through which the surgeon inserts specialized surgical instruments. The surgeon manipulates these instruments to perform the adrenalectomy. Following the procedure, the small incisions are closed with sutures and covered with surgical tape. After a few months, they are barely visible.
What are the benefits of laparoscopic adrenalectomy?
• Three or four tiny scars instead of one large abdominal scar
• Less risk of hernia development
• Less chronic pain resulting from nerve damage
• Reduced postoperative pain
• Shorter hospital stay – you may leave one or two days after surgery
• Shorter recovery time – days instead of weeks – and quicker return to daily activities, including work
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Although many people feel better in just a few days, you may need to take it easy for two to four weeks.
How safe is laparoscopic adrenalectomy?
If performed by experts in this field, laparoscopic adrenalectomy is as safe as “open” surgery in carefully selected cases.
Appointment
To schedule an appointment, please call the Urological Institute at 216-444-5600.
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A Minimally Invasive Approach to Kidney Donation
Laparoscopic Live Donor Nephrectomy
What is a laparoscopic live donor nephrectomy?
A laparoscopic live donor nephrectomy is a minimally invasive surgical procedure for removing a kidney from a living donor.
When is this procedure used?
Laparoscopic live donor nephrectomy is used when a living donor wishes to donate a kidney to a friend or relative who has renal failure.
What does this procedure involve?
Unlike a conventional nephrectomy, laparoscopic surgery requires only several tiny, button-hole incisions; the kidney ultimately is removed through a seven centimeter, bikini area incision, and none of the incisions cuts muscle. Through these incisions, a surgeon uses a powerful endoscope – a tiny camera – and specialized surgical instruments to remove the donor kidney.
How long does this surgery take?
Surgery takes approximately three hours, and the hospital stay is usually just one to two days. Full recovery usually takes about three weeks.
What are the advantages of this procedure?
Traditional donor kidney surgery requires a 10- to 12-inch incision, at a minimum. Also, the open surgery incision is made through muscle and usually requires removal of a rib. The minimally invasive technique requires only three to four buttonhole incisions for the surgical instruments.
Patients benefit from:
• Reduced hospital stay (one to two days average) and faster healing
• Less postoperative pain and less need for pain medication
• Shorter recovery time
• Quicker return to normal activity (about a week) and work (about two to three weeks)
• Smaller incisions and less scarring
• Fewer complications
A major benefit of this procedure is the ability to find a match among non-blood relatives, such as spouses and friends. Because the kidney is transplanted into the recipient immediately, the chances of rejection are significantly reduced.
How long has The Cleveland Clinic been performing laparoscopic live donor nephrectomies?
Since 1998, Cleveland Clinic urologists are among a handful of physicians in the world – and the only ones in northeast Ohio – to offer laparoscopic donor nephrectomies. The Cleveland Clinic has the most experience of any health care center in the state related to live donor nephrectomies.
Currently, more than 95% of the live donor nephrectomies performed are done laparoscopically.
We attempt to make the expertise of our kidney transplant team available to as many patients as possible. Cleveland Clinic urologists perform transplants at hospitals in Youngstown and Akron, Ohio, and in Charleston, W.Va.
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Female Urinary Incontinence
Burch Procedure
Loss of bladder control is not a disease. Rather, it is a sign that a problem may exist. Regular leakage of urine can occur with certain movements, during pregnancy or times of stress. When leakage of urine becomes frequent or severe enough to become a social or hygienic problem, it is called urinary incontinence. Any leakage of urine that you cannot control should prompt you to see your doctor. Proper diagnosis and treatment may correct the problem and ease the symptoms of urinary incontinence. If surgery is the form of treatment your doctor recommends, physicians at the Cleveland Clinic who specialize in this procedure can determine if laparoscopic surgery is appropriate for you.
How is the laparoscopic Burch (bladder neck suspension) performed?
Laparoscopic surgery uses a thin, telescope-like instrument known as an endoscope which is inserted through a small incision at the umbilicus (belly button). The endoscope is connected to a tiny video camera – smaller than a dime – which projects an “inside” view of the patient’s body onto television screens in the operating room. The abdomen is inflated with a gas (carbon dioxide) to allow your doctor to view your internal structures. By lifting tissue adjacent to the bladder, the “bladder neck suspension” procedure alleviates the pressure placed on the urethra. Following the procedure, the small incisions are closed with a stitch or two or with surgical tape. Within a few months, the incisions are barely visible.
What are the benefits?
• Three or four tiny scars instead of one large abdominal incision
• Shorter hospital stay (you may leave the day of surgery or the first day after surgery)
• Reduced postoperative pain
• Potentially lower hospital costs
• Faster return to work
• Shorter recovery time and earlier resumption of daily activities (a recovery time of days instead of weeks)
What can I expect after surgery?
It is important to follow your doctor’s instructions after surgery. Many people feel better in just a few days, however you may need to take it easy for two to four weeks.
How safe is laparoscopic surgery for urinary incontinence?
This procedure is as safe as “open” surgery, in carefully selected cases, when performed by specialists in this field.
Appointment
To schedule an appointment, please call the Urological Institute at 216-444-5600.
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A Minimally Invasive Approach to Kidney Removal
Laparoscopic Simple Nephrectomy and Laparoscopic Radical Nephrectomy
What is laparoscopic nephrectomy?
A laparoscopic nephrectomy is a minimally invasive surgical procedure for removing a kidney.
When is this procedure used?
Laparoscopic simple nephrectomy is suitable for patients with benign conditions resulting in end-stage kidney disease (kidney failure) including infection, stones, obstruction, dysplasia and renal vascular hypertension.
Laparoscopic radical nephrectomy is an excellent minimally invasive treatment for the majority of localized renal tumors, up to 12 to 15 centimeters in size.
What does this procedure involve?
Unlike a conventional nephrectomy, laparoscopic surgery requires only several small incisions. Through these incisions, a surgeon uses a powerful endoscope – a tiny camera – and specialized surgical instruments to conduct the operation and remove the kidney.
How long does this surgery take?
Surgery takes approximately 2 to 21/2 hours, and the hospital stay is usually just overnight, even for large tumors.
What are the advantages of this procedure?
The Cleveland Clinic is the only medical center in the United States where the retroperitoneal (behind the peritoneum) approach is used consistently for laparoscopic radical nephrectomy. Technically more advanced, Clinic urologists believe this approach offers significant advantages to the patient, including:
• Avoidance of potential bowel complications
• Reduced hospital stay (one day in younger, healthy patients) and faster healing
• Less postoperative pain and less need for pain medication
• Quicker return to normal activity and work
• Smaller incisions and less scarring
How long has the Cleveland Clinic been performing laparoscopic radical nephrectomies?
The Cleveland Clinic was the first medical center in Ohio to perform laparoscopic radical surgery for kidney disease, beginning in 1997. The Clinic now offers laparoscopic options for a majority of kidney diseases and has, by far, the most experience with laparoscopic surgery for kidney cancer in the United States.
How many laparoscopic radical nephrectomies have Cleveland Clinic urologist performed?
To date, the Urological Institute laparoscopic team has performed more than 350 such procedures for both benign and malignant diseases.
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A Minimally Invasive Approach to Kidney Tumors
Laparoscopic Cryoablation
What is laparoscopic cryoablation?
Laparoscopic cryoablation is minimally invasive surgical procedure that freezes and destroys small kidney tumors.
When is this procedure used?
Laparoscopic cryoablation is used to treat small (up to 4 centimeters) renal tumors. In appropriately selected patients, it offers an alternative to open surgical or laparoscopic partial nephrectomy.
What does this procedure involve?
Unlike a conventional partial nephrectomy, laparoscopic surgery requires only three to four button-hole incisions. Through these incisions, a surgeon uses an endoscope – a tiny camera – and specialized surgical instruments to conduct the operation. With the tip of a freezing probe, the diseased portion of the kidney is removed. Puncture cryoablation, which requires a pericutaneous skin puncture to deliver the cryotherapy, is performed under magnified laparoscopic visualization and ultrasound monitoring.
How long does this surgery take?
Surgery takes approximately 2 to 21/2 hours, and the hospital stay is usually just one day. Full recovery usually takes about two to three weeks.
What are the advantages of this procedure?
Traditional surgery for tumor removal requires a 10- to 12-inch incision, at a minimum. The minimally invasive technique requires three to four tiny incisions for the surgical instruments.
Patients benefit from:
• Reduced hospital stay (one day) and faster healing
• Less postoperative pain and less need for pain medication
• Shorter recovery time
• Quicker return to normal activity (about a week) and work (about two weeks)
• Smaller incisions and less scarring
• Fewer complications
What about follow up?
Patients are followed closely with sequential MRI scans at one, three and six months, as well as a CT-controlled needle biopsy at six months.
How long has the Cleveland Clinic been performing laparoscopic cryoablation?
The Cleveland Clinic has the most experience of any health care center in the world related to laparoscopic cryoablation. Our specialists have been performing laparoscopic cryoablation for three years.
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A Minimally Invasive Approach to Prostate Cancer
Laparoscopic Radical Prostatectomy
What is a laparoscopic radical prostatectomy?
Now a routine procedure at the Cleveland Clinic, laparoscopic prostatectomy is a minimally invasive surgery procedure used to remove the prostate.
When is this procedure used?
Laparoscopic prostatectomy is used to treat patients who have prostate cancer. We offer this procedure to all patients who are candidates for open radical prostatectomy.
What does this procedure involve?
Unlike traditional open surgery, laparoscopic surgery requires only four to five small, button-hole incisions, through these incisions, a surgeon uses a powerful, high-precision endoscope – a tiny camera – and specialized surgical instruments to remove the prostate.
How long does this surgery take?
Although this surgery takes approximately 31/2 hours to perform, patients generally feel much better and have significantly fewer pain requirements in the early operative period. Unlike open surgery where the catheter stays in for two to three weeks, laparoscopic prostatectomy patients have their Foley catheters removed on the seventh day after surgery.
What are the advantages of this procedure?
Traditional surgery for tumor removal requires an eight-inch incision, at a minimum. The minimally invasive technique requires four to five tiny incisions (of less than half an inch) for the surgical instruments. Laparoscopic prostatectomy offers surgeons unparalleled visualization of the area, thus permitting precise removal of the prostate. Patients also experience significantly less blood loss.
Additionally, patients benefit from:
• Reduced hospital stay (11/2 days average) and faster healing
• Less postoperative pain and virtually no need for pain medication
• Shorter recovery time
• Quicker return to normal activity (one to two weeks) and work (two to three weeks)
• Shorter incisions and less scarring
How long has the Cleveland Clinic been performing laparoscopic prostatectomies?
The Cleveland Clinic has the most experience of any health care center in the United States related to laparoscopic prostatectomy. Our specialists have been performing laparoscopic prostatectomy procedures for the past year. We are investigating the long-term effects of the procedure versus the open radical prostatectomy. Preliminary results suggest that return to continence and potency is comparable to that of the open procedure.
Patients are informed of the option of having a laparoscopic radical prostatectomy, with the condition that an open procedure may be necessary if the laparoscopic technique cannot effectively remove the entire prostate. This is rare.
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A Minimally Invasive Approach to Cancer of the Renal Pelvis and Ureter
Laparoscopic Radical Nephroureterectomy
What is a laparoscopic radical nephroureterectomy?
Laparoscopic radical nephroureterectomy is a minimally invasive surgical procedure to remove the renal pelvis, kidney and entire ureter, along with the bladder cuff, in an attempt to provide the greatest likelihood of survival.
When is this procedure used?
Laparoscopic radical nephroureterectomy is used to treat patients who have transitional cell cancer of the upper urinary tract.
What does this procedure involve?
Unlike a conventional nephroureterectomy, laparoscopic surgery requires only several small incisions. Through these incisions, a surgeon uses a powerful endoscope – a tiny camera – and specialized surgical instruments to remove the diseased organs.
How long does this surgery take?
Surgery takes approximately 31/2 hours, and the hospital stay is usually one to two days. Full recovery usually takes two to three weeks.
What are the advantages of this procedure?
• Reduced hospital stay and faster healing
• Less postoperative pain and less need for pain medication
• Shorter recovery time
• Quicker return to normal activity or work
• Smaller incisions and less scarring
How long has the Cleveland Clinic been performing laparoscopic radical nephroureterectomies?
The Cleveland Clinic has the most experience of any health care center in the world with this technique and, since 1997, has been employing this procedure routinely with excellent results.
The Cleveland Clinic was one of the first centers to perform Renal transplantation since the mid 1960’s. Currently, more than 95% of the radical nephroureterectomies performed are done laparoscopically.
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