'Keyhole' surgery: less pain, faster recovery

by Anup Ramani, M.D., M.C.H.

October 7, 2005

No one relishes the thought of having surgery. Pain, a long recovery, and a big scar are dreaded side effects of going under the knife. But it doesn't have to be that way anymore. Laparoscopic surgery is a way for physicians to accomplish the same or better outcomes in a much less painful fashion.

Often called keyhole surgery, laparoscopic surgery offers excellent outcomes with significantly less pain, smaller incisions, and speedier recoveries for patients with urological cancers (prostate, kidney, adrenal) and most other urological conditions. It is now the norm for many procedures at major hospitals in the country, including University of Minnesota Medical Center, Fairview, and its Advanced Laparoscopic Surgery Clinic.

When performing laparoscopic prostatectomy, a state-of-the-art keyhole surgery for treating prostate cancer, physicians make five tiny incisions (compared to a 13- to 15-centimeter incision for "open" surgery). The surgeon then inserts surgical tools and a laparoscope—a slim telescope with a camera attached—into the abdomen, which magnifies the entire abdomen and ensures much better vision than open surgery. Doctors then perform the procedure just as they would during traditional surgery.

Laparoscopic surgeons can perform a prostatectomy with significantly less blood loss, less pain, and much smaller scars than traditional surgery. Patients typically go home the next day instead of three to five days after traditional surgery. With keyhole surgery, patients generally need a catheter only for five days, compared to three weeks after traditional surgery, and they are less likely to have problems with incontinence and impotence. Most patients are back to work in two to three weeks. An increasing number of patients are now asking their physician for this technique to treat their prostate cancer.

Keyhole surgery also offers many options to patients with a kidney tumor. Instead of a 15-centimeter cut through three major muscle groups, only three small incisions are needed to remove the kidney using laparoscopic surgery. For appropriate patients, surgeons often can remove only the portions of the kidney with the tumor instead of the whole organ.

After this keyhole surgery, patients typically return home the next day and can go back to work in a couple of weeks. With traditional surgery, they typically have to stay in the hospital for three to six days and recover at home for at least six weeks.

Other state-of-the-art procedures include:

• Laparoscopic cryoablation, where kidney tumors are frozen to spare most of the kidney
• The laparoscopic removal of adrenal gland tumors, and
• Laparoscopic pyeloplasty for kidney obstructions.

In all three procedures, patients go home either the same evening or the next day.

Contrary to myths about keyhole surgery, there are no surgical shortcuts. Laparoscopic surgeons don't do anything differently than open surgeons; they just enter the body differently. Laparoscopic surgery is still rare because few physicians are trained in it, but it's worth asking your doctor if it's an option for you.

Anup Ramani, M.D., M.C.H., is a laparoscopic urological surgeon and director of the Advanced Laparoscopic Surgery Clinic at the University of Minnesota. He sees patients through University of Minnesota Physicians. Contact him at mailto:keyholedoc@yahoo.com or 612-625-3209. This column is an educational service of the University of Minnesota. Advice presented should not take the place of an examination by a health-care professional. For more health-related information, go to http://www.healthtalk.umn.edu.