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The kidneys perform important tasks in the human body. They detoxify the organism and form vital hormones. For example, if the kidney is attacked by a tumor disease, surgery is often the most effective therapy.
Like any organ, the kidney may be affected by disorders and diseases. Dr. Manski provides an overview in the Urology Online Textbook:
- Malformations (eg cystic kidney)
- Injuries (such as an accident)
- Disease of the blood vessels (eg. renal vein thrombosis)
- Urinary tract infections
- Dysfunction (such as diabetes)
- Kidney stones
- Kidney cancer / kidney tumor / renal cell carcinoma
About three percent of all tumors are diagnosed with "renal cell carcinoma" (kidney cancer). Renal cell carcinomas usually form in the cells of the fine urinary tract.
Surgery allows physicians to remove affected areas of the kidney. This partial kidney resection preserves the healthy part of the kidney. Not always can the surgeon save the organ. Very large tumors or tumors in unfavorable places require a radical nephrectomy, ie a complete removal of the affected kidney. The lymph nodes are also surgically removed.
Basically, the doctors try to get the kidney as much as possible. Recent research has shown that the rate of relapse does not increase if the healthy parts of the kidney remain in the body.
If the procedure is successful and the patient otherwise healthy, no further treatment is necessary. Older patients and people with pre-existing conditions must check with their doctor if surgery is helpful for them. The reason: Small tumors grow very slowly in old age and usually do not form metastases.
Over the past twenty years, laparoscopic surgery has gained widespread currency in urology. Urological laparoscopy is a kind of operation, which is performed on renal organ ducts without making large incisions in skin or muscles. This branch of medicine is called laparoscopic urology and it seems to be gradually supplanting various types of open surgery, which have been in practice for centuries.
A few decades ago, kidney and/or urethra removal surgeries required a 30-cm incision. Not infrequently, such operations involved blood transfusion and a two-week-or-so hospital stay for rehabilitation. Following dismissal, patients’ condition remained serious for about the same period of time. Incisions would leave big scars.
What is Laparoscopy?
Laparoscopy was introduced in the 1970s to diagnose urological conditions, such as abdominal cryptorchidism, hydronephrosis, kidney cancer, unilocular cysts, multicystic kidney disease. Initially, doctors used cytoscopes – a kind of endoscope featuring an optical system inside a metal box. In the late 1980s, new laparoscopic procedures, such as pelvic lymphadenectomy and tying off varicoceles, were introduced. In the early 1990s, new nephrectomy, ureterolithotomy, cyst excision, cystectomy, etc. methods were developed. Today, there are hardly types of urological surgeries out there not performed through laparoscopy.
Laparoscopic surgery lies in accessing the affected organ through three to four punctures, through which special kinds of instruments and a miniature video camera are inserted into the body, under general anesthesia. The surgeon cuts through the abdomen and introduces instruments into the retroperitoneal space, where kidneys, renal ducts and related vessels are located. The image is displayed on a TV screen. Laparoscopic instruments measure 5-10 mm in diameter. These operations are technically challenging and require exceptional skills. However, they are definitely more effective than laparotomic operations. Optical augmentation provides a more detailed view of internal organs and enables doctors to perform high-precision manipulations with less damage to tissues and minor blood loss. Post-operation rehabilitation requires only a few-hour intensive care without much painkilling. Post-laparoscopic patients regain the ability to walk and eat much earlier than post-laparotomic patients. Last, but not least, scars are barely visible after healing.
Laparoscopic surgery gains widespread currency in treating a variety of urological diseases. The main types of surgery include:
- Nephropexy is performed to correct nephroptosis. Laparoscopic surgery helps place and fix a kidney in the right position.
- Nephrectomy is used to treat both benign (secondary shrunken kidney, impaired development, kidney dysfunction) and malignant kidney conditions.
- Adrenalectomy is surgical removal of the adrenal gland affected by benign and malignant tumors.
- Ligation and dissection of the internal spermatic vein is performed in patients dealing with varicocele. Laparoscopy reduces recurrence rate to 1-2%.
- Excision of kidney cysts, particularly multi-chamber, big-sized and recurrent ones.
- Heminefrectomy is an operation to remove affected part of a kidney.
- Pyeloplasty is the surgical reconstruction of the kidney pelvis and ureter in patients suffering hydronephrosis.
- Kidney biopsy is sampling tissue for examination.
- Uretherolithotomy is an operation to remove big urethral stones in cases whereby other methods (for example, lithotripsy) are no longer effective.
- Radical prostatectomy is a surgery to remove the prostate gland affected by cancer.
- Pyelolithotomy is an operation to remove stones.
- Pelvic lymphadenectomy is an operation to remove pelvic lymphatic nodes affected by malignant tumors.
- Radical nephrectomy is an operation to remove an entire kidney or part of it affected by benign or malignant tumors.
Today, the advantages of laparoscopic treatment of urological diseases over traditional open surgery are undoubted. Minimal damage, quick rehabilitation, short hospital stays and quick return to normal life are the most significant benefits of such operations, to name a few. Although we are dealing with an intensive patient flow, it is our credo that we exercise an individual approach to each patient and maintain contact with doctors sending them to us.