LAPAROSCOPY IN UROLOGY
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NON LAPAROSCOPIC PROCEDURES
ESWL – (Extracorporeal Shock Wave Lithotripsy)
This is a simple non invasive technique by which stone is powdered inside the kidney. Our modern machine, does not require general anesthesia as it produces, very little pain. Hence this is an out patient procedure, not requiring admission.
A mechanical shock wave is generated under water and focused on the stone by special machines. The shock wave cause cracks to form in the stone. Urine gets in to these cracks and cause fragmentation. This fragmentation may take from 1 to 14 days.
Stones in the kidney and upper ureter less than about 2.5cm size and not obstructing the kidney completely, can often be treated by ESWL. Such stones can also be treated by other techniques such as PCNL and Laparoscopy or open surgery. The advantage of ESWL, is that it avoids any wound on the skin, and is an outpatient procedure, not requiring anesthesia (in our hospital).
However there are a few disadvantages. The fragmented stones take a few days to clear from the urinary passage. During their transit the fragments may cause discomfort in spite of the medicines the doctor prescribes to prevent this. If the stone has not fragmented completely in the first session, further sessions will be required at 3 weekly intervals. ESWL is successful in 80% of cases. In 20%, when ESWL falls, either PCNL. Laparoscopy or Open Surgery is required. Though ESWL is the cheapest and most convenient method of stone treatment, in this 20% requiring multiples sessions and or additional procedures, the treatment cost would be more than if the stone was treated primarily by PCNL or Open surgery. PCNL is successful in 90% of the cases and Open surgery in 95% of cases.
PCNL – under anesthesia, a single track is put in to the kidney, through the back. A telescope is then passed through the track to visualize the stone and powder it. The fragments are then taken out through the track. It requires about 7 days of admission.
LAPAROSCOPY – Instead of open surgery, 3 or 4 key holes are used to reach the ureter. The operation field is then visualized through a telescope connected to a camera. The stone is then removed as in open surgery. It requires about 7 days of admission and the pain as compared to open surgery is very much less. When open surgery requires 6 weeks rest, laparoscopic surgery requires only 7 days rest.
1 You can have a light diet - non gas forming - regular meal before the procedure.
2 You should have had plenty of fluids as stones break better if there is a good urine output.
3 No anaesthesia is required as the procedure produces little pain.
4 You will be sedated to prevent you from moving. Movement causes the focus of the shockwaves to shift from the stone. Though this will not produce any damage to surrounding structures, stone fragmentation will not be effective.
5 The machine produces a very loud noise as each mechanical shock wave is produced. To decrease the sound an ear muff will be placed over your ears to muffle the sound.
6 You will be kept in hospital for another 2 to 3 hours or until you are free of sedation and safe enough to travel.
7 You cannot drive home - you can travel as a passenger, but not on a 2 wheeler.
1 A list of medicines will b given to help pass the stone fragments. Medicine for any pain during passage of the stone fragments will also be given.
2 You should sieve urine and bring all the fragments for stone analysis. Suitable sieve is available in the pharmacy.
3 Complete fragmentation may take upto 2 weeks. Therefore, next outpatient review is usually afer 10 days.
4 You should take an X-ray on an empty stomach in the morning before seeing the doctor in the outpatient clinic at the time of outpatient review. Therefore 2 types of tablets given to you at discharge for decreasing the gas content in the intestines , should be taken the day before.