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| Vol. 21, No. 13 |
| July 15, 1999 |
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Nephrectomies Are Done with Laparoscopic Surgery by STEFANIE ASIN Methodist Health Care System Patients needing kidney surgery now have the option of a laparoscopic procedure that quickens recovery and makes the size of scars smaller. Dr. Peter Schulam, a urologic surgeon at The Methodist Hospital's Urology Institute and an assistant professor at Baylor College of Medicine's Scott Department of Urology, is one of two doctors in Texas performing laparoscopic nephrectomies (removal of the kidney). He is the only urologist providing the procedure in Houston. Instead of an 8- to 12-inch incision, laparoscopic nephrectomies only require several small incisions, less than an inch long, around and in the belly button. Dr. Schulam says laparoscopic nephrectomies are not always the appropriate treatment, but there are many advantages to this minimally invasive surgery. "With this new procedure, there is less post-surgery discomfort, a shorter hospital stay, decreased convalescence, the ability to return to work sooner, and an improved cosmetic result," says Dr. Schulam. "As technology advances and surgical skills improve, the number of laparoscopic procedures will undoubtedly increase," he says. The procedure is not only used for nephrectomies but also can be used for treating cysts and for performing reconstructive renal surgery. Laparoscopic surgery involves the use of a tiny scope, which gives the surgeon a view of the inside of the abdomen. A typical laparoscopic procedure for kidney removal begins by filling the abdomen with carbon dioxide gas to enlarge the surgical area. Then two half-inch incisions and one quarter-inch incision are made and trocars, or tubes, are placed into the abdomen to provide channels for the camera and instruments. A robotic arm is used to hold the scope and is directed by the surgeon's voice. The scope is attached to a camera that projects the image onto a monitor. This voice-activated arm allows the surgeon to control the surgical field and provides a stable image without the need for additional staff. The kidney, about the size of a large potato, is freed and then an instrument releases a "bag" into the abdomen. The kidney is then placed into the bag and the opening of the bag is pulled through one of the incisions. The kidney can then be pulverized in the bag and removed from the small incision.
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