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    Urology Procedures

    Laparoscopic cryoablasion for exophytic renal tumors

    Laparoscopic cryoablasion of exophytic renal tumors is performed through the use of ultra-cold argon gas applied with special laparoscopic probes directly into the tumor, resulting in freezing and death of the tumor cells. A exophytic renal tumor is a tumor that grows outward, beyond the surface of the kidney. Another approach, laparoscopically, is wedge resection of the tumor, or a laparoscopic partial nephrectomy.

    Laparoscopic ultrasound is used to identify and characterize the tumor, to guide the cryoprobe, and to monitor the progression of the iceball formed by the argon gas, which freezes the tumor. The cryoprobe is inserted and when proper placement is confirmed by ultrasound, the freezing process is begun. The freezing is completed once the tumor tissue reaches temperature of negative 165° C and the iceball has obtained a 1cm margin beyond the tumor edge. If a wedge resection is performed, a special glue is used to seal the cut surface of the kidney.

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    Laparoscopic bladder diverticulectomy

    A bladder diverticulectomy is the repair of diverticulum, which is an abnormal sac or pouch causing incomplete voiding of the urinary bladder. Diverticulum are associated with increased incidence of infection, urinary tract stone development and carcinoma. Using a laparoscope, a diverticulectomy is performed to remove the pouches or sacs and return the bladder to its original shape and size. Sometimes this procedure is performed using the DaVinci® Robot.
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    Laparoscopic vaginal colposacropexy

    Vaginal colposacropexy is a surgery preformed for severe vaginal prolapse. Caused by the weakening of muscles, prolapse cases requiring surgery are generally for conditions where the uterus or vagina has protruded through the vaginal opening. Usually approached vaginally, this surgery is sometimes performed through the abdomen. Using laparoscopic equipment, three to four small incisions are made in the abdomen to insert the telescopic camera and surgical instruments, the vagina is reattached to the sacral bone.
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    Laparoscopic bladder neck suspension

    Laparoscopic bladder neck suspension is a special surgical procedure that adds support to the bladder to reduce urinary incontinence. This condition most often affects women over forty years of age. This laparoscopic method uses two to three incisions of less than 1/2 inch to place stitches or surgical staples to attach the bladder support area to the pelvic bone. This suture lifts the tissues upward, returning the bladder neck to normal position, minimizing the involuntary leakage of urine. Patients recover in 4 to 6 days from this outpatient suspension procedure.

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    Laparoscopic pyeloplasty

    Uretero-pelvic junction obstruction can be corrected utilizing laparoscopic pyeloplasty. Often, this procedure is performed using the DaVinci® Robot.
    The urine drains from the kidney into the ureter, then to the bladder. In some patients, children or adults, the junction between the kidney and ureter, called the uretero-pelvic junction or UPJ, can become obstructed. This obstruction can be caused by fibrous scarring, a blood vessel which crosses the junction causing it to kink, or other factors.

    Repairing UPJ obstruction traditionally required open surgery, with an extensive incision along a patient's side. The open surgery requires that patients remain in the hospital for 3 to 6 days and involves a lengthy recovery period, from 4 to 8 weeks.

    In a laparoscopic pyeloplasty, a small incision is made near the umbilicus through which a small camera is inserted to view the inside of the abdomen. Additional incisions are made through which instruments used to perform the surgery are inserted. Once the instruments are in place, actual surgical repairs are performed identically to traditional open surgery.

    There are many advantages to laparoscopic pyeloplasty. There is a 95% success rate, postoperative pain is greatly reduced so patients can more quickly return to normal activity, and the average hospital stay is 2 to 3 days. Alternative procedures include endopyelotomy which your surgeon can discuss with you.

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