Wednesday, Jul 16, 2003
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Andhra Pradesh-Hyderabad
By S. Nagesh Kumar
With its inherent advantages like shorter hospitalisation and post-operative convalescence, laparoscopy is being used in a wide variety of surgical procedures ranging from radical nephrectomy (removal of the kidney) to the more commonplace operation for removal of ureteric stones. Use of laparoscopy in urology began a decade ago but is catching up so fast that advances have been made even in paediatric urology to treat congenital problems such as undescended testes. Corporate hospitals in the city have made rapid strides in laparoscopic surgery because patients realise its twin advantages over open surgery -- less pain and less bleeding. N. Mallikarjuna Reddy, a laparoscopic urologist in Apollo Hospitals, told The Hindu that studies had shown that complications during and after laparoscopy were no worse than those observed during and after open surgery. Dr. Reddy, who participated in a pre-conference workshop of the Urological Society of India, South Zone, at Chennai last week, said his own experience after performing more than 250 laparoscopic surgeries, including 60 on children, was very encouraging. Making a comparison, he said 11th rib had to be removed to get access to the kidney in open surgery. On the other hand, two working ports (incisions) of about 5 to 10 mm length had to be made in laparoscopic surgery. The diseased kidney, if damaged beyond repair, could be removed in small parts through the port. The patient could get back to work within three to four days after surgery. He said patients with non-functioning kidneys caused by congenital problems could find an ideal solution through laparoscopy. The problem could be tackled by removing the obstruction at the pelvi-ureteric junction through a procedure called pyeloplasty. Obstructions between the kidney and the ureter leading to loss of the former's functions could also be removed. Dr. Reddy said laparoscopy had been effectively used even for ureteric re-implantation to treat cases in which urine goes from the bladder to the kidney causing it to swell. In these cases, the patient suffers from urinary tract infection and fever. ''We remove the ureter from the bladder and put it back after making it non-obstructive''. The urologist said many women had benefited from this procedure after suffering from vesico-vaginal fistula, a condition which results in constant draining of urine. He had documented a procedure he had performed and sent it for publication to the British Journal of Obstetrics and Gynaecology, he added.
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