ENDOSCOPIC SURGERY

Endoscopic surgery is a minimally invasive procedure that utilizes an endoscope to reach internal organs through very small incisions.

During endoscopic surgery the surgeon inserts a thin, flexible tube with a video camera through a small incision or a natural orifice like the mouth or nostrils. The tube has a channel to utilize tiny surgical instruments, which the surgeon uses while viewing the organs on a computer monitor.

This technique allows the surgeon to see inside the patient’s body and operate through a much smaller incision than would otherwise be required of traditional open surgery.

Types of Endoscopic Surgery

Retrograde Fashion: In this procedure, the approach is made from the lower part of the urinary tract up. The patient is placed to sleep. The legs are propped up in stirrups. Using a fiberoptic scope (ureteroscope) connected to a camera, the surgeon watches a television monitor as the scope is inserted into the bladder, then advanced into one of the ureters. Often fluoroscopy, or real-time x-ray, is used to guide the course. Depending on the disease in the ureter, a plastic tube, called the stent, may be passed into the ureter to connect the kidney with the bladder. This is used to bypass any stones, strictures, or blockage of the ureter in order to drain urine. Often, the surgeon may use laser to break up stones or strictures.

Percutaneous Fashion: This means to approach the kidney through the skin. Often the patient already has a tube (nephrostomy tube) inserted into the affected kidney by the interventional radiologist. The patient is then placed to sleep. He/she is turned onto his/her belly, exposing the back. The nephrostomy tube tract is dilated to approximately nickel-size diameter. Using a fiberoptic scope, the surgeon sees the kidney. Kidney stones, ureteropelvic junction obstruction, and sometimes tumors or unknown tissues are treated through the tract in this fashion. Often the surgeon will leave a tube in the kidney to drain the urine, and any clots or stones. Within the next few days, dye is injected into the tube, and an x-ray is taken. If the kidney is draining well, the tube may be removed, and the patient is discharged home.