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Minimally Invasive Surgery
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Determining the Best Course of Treatment for You
Urologists at the Lahey Hospital & Medical Center Institute of Urology have earned an international reputation as leaders in the field of minimally invasive urologic surgery. The Institute’s progressive environment continues to attract surgeons and residents from around the world who take a special interest in the development of laparoscopic techniques.
While the notion of surgery has changed dramatically with the advent of minimally invasive techniques and robotic technology, a urologist’s surgical skill and experience in determining the best course of treatment remains paramount.
At Lahey Hospital & Medical Center, teams of specialists work together to pinpoint the most appropriate surgical approach for each patient. When deemed a viable alternative to open surgery, traditional and robot-assisted laparoscopic methods are preferred. In some cases, however, surgeons may recommend open surgery as the means to the best possible outcome.
Laparoscopic techniques pioneered by members of the Center for Minimally Invasive Urologic Surgery have had significant impacts on the lives of men and women with urologic cancer.
‘Open’ versus ‘Laparoscopic’ Surgery
Over the last decade, advances in technology have allowed surgeons to perform laparoscopic or “keyhole” surgery through tiny incisions, without the surgeon’s hand ever entering the abdominal cavity. As a result, operations that previously required large, eight- to ten-inch incisions are now performed through three to four small (0.5 to 1-cm) incisions.
Both traditional and robot-assisted (“keyhole surgery”) laparoscopic surgery is performed with the help of an endoscopic camera and several long, thin instruments that enter the body through tiny incisions. At Lahey Hospital & Medical Center, operating rooms contain advanced video, lighting, computer and robotic technology that allow the doctors to view the tools close-up, guide them through the body and monitor the operation in detail on large screens. A specialized videoconferencing system allows for two-way interfacing between operating rooms and physicians’ offices, providing opportunities for collaboration and education.
Advantages of Laparoscopy & Robotic Laparoscopy
Advantages for patients:
- Avoidance of a large incision
- Decreased blood loss
- Reduced postoperative pain and discomfort
- Shorter hospital stay
- Faster recovery time
- Improved cosmetic result
Advantage for surgeons:
- Magnification of tissues and structures through the optical system
- Greater precision
- More delicate handling of sensitive structures (i.e. vessels, nerves)
Specialized Surgical Training
Minimally invasive laparoscopic and robotic surgery requires very different skills than traditional open surgeries. In addition to completing traditional surgical residencies and fellowships, Lahey surgeons go through rigorous training in order to perform both traditional and robotic laparoscopy. At the Lahey Hospital & Medical Center MAST (minimal access surgery and technology) Center, laparoscopic techniques are practiced and refined through the use of inanimate surgical training tools.
Robotic Urologic Surgery
The expert surgeons at Lahey Hospital & Medical Center’s Institute of Urology can perform nearly all major abdominal urologic procedures – cancerous and noncancerous – via a minimally invasive approach with robotic-assisted and laparoscopic techniques.
These surgeries are routinely performed through several small “keyhole” incisions, which may result in less pain, better cosmetic results and earlier recovery for patients.
Lahey was one of the first centers in the nation to offer laparoscopic radical prostatectomy. Our surgeons were early adopters of robotic surgery and have performed thousands of minimally invasive urologic procedures.
Robotic Urologic Procedures at LHMC
Prostate
- Simple prostatectomy – Most of the prostate removed for noncancerous enlargement, also known as benign prostatic hyperplasia or BPH.
- Radical prostatectomy – Entire prostate removed for prostate cancer.
- Radical cystoprostatectomy with extended pelvic lymph node dissection and intracorporeal diversion – Entire bladder, prostate and lymphatic tissue removed for bladder cancer and then reconstruction performed robotically for urine drainage.
Kidney
- Partial nephrectomy – Portion of kidney removed for kidney cancer.
- Radical nephrectomy – Entire kidney removed for kidney cancer.
- Radical nephroureterectomy – Entire kidney, ureter, bladder cuff removed for transitional cell cancer of the kidney.
- Renal cyst decortication – Opening of large, painful, fluid-filled sacs within the kidney.
- Renal diverticulectomy with stone removal – Removal of stones from outpouchings of the kidney when not accessible by other means.
Bladder
- Diverticulectomy of the bladder and stone removal – Removal of large bladder outpouchings with associated stones.
Adrenal
- Radical adrenalectomy – Entire adrenal gland removed for cancer.
- Adrenalectomy – Adrenal gland or portion of removed for noncancerous growth such as adrenaline-producing tumors known as pheochromocytoma, aldosterone-producing tumors and cortisol-producing tumors known as Cushing disease.
Penile
- Inguinal lymph node dissection – Groin lymph node removal for cancer of the penis.
Ureters
- Ureteral reimplantation with psoas hitch or Boari flap – Complex reconstruction of the ureters using bladder tissue for certain tumors within the ureter, or for extensive scar tissue of the ureters typically from a prior surgical procedure or stone disease.
- Pyeloplasty – Surgical correction for narrowing at the junction where the ureter joins the kidney.
- Ureterolysis with omental flap – Separation of the ureters from surrounding inflammatory tissue to allow drainage.
- Robotic donor nephrectomy with auto-transplantation – For severe scar tissue of the ureter for total bypass of the ureter, done in conjunction with our transplant-trained surgeons.
Our Expert Robotic Team
Led by Ali Moinzadeh, MD, our robotic team consists of a highly trained group of experts in the field of minimally invasive urologic surgery. We have extensive experience with advanced robotic surgery as we have been performing such procedures for more than a decade.
We take a multidisciplinary approach by collaborating with our hematology and radiation colleagues to identify the best treatment plan for all of our patients. Our robotic surgery team members are:
- David Canes, MD
- Marc D. Manganiello, MD
- Ali Moinzadeh, MD
- Andrea Sorcini, MD
- Harras B. Zaid, MD
- Michelle Lavery, NP (nurse practitioner)
- Susan Palmer, NP (nurse practitioner)
Ablative Treatment of Kidney Cancer
Ablative therapy for renal masses (kidney cancer) uses an array of energy sources to treat renal tumors. The tumor is either super-cooled (cryotherapy) or super-heated (radiofrequency ablation) using a probe placed into the kidney tumor. The objective is to destroy the cancerous tissue without physically removing the cancer.
Traditionally, most of these procedures were performed with laparoscopic assistance, but today they are performed robotically, with the probe placed through a very small incision in the skin. These procedures are performed in conjunction with interventional radiologists and may be a treatment option for patients with small kidney tumors.
