Minimally invasive laparoscopic urologic surgery is becoming more common. The goals of laparoscopic procedures are to minimize postoperative pain, to allow for a more rapid return to normal activities, and decrease the length of the hospital stay. The smaller incisions allow a better cosmetic result.

Laparoscopic Procedures offered:

Diagnostic Laparoscopy
We use laparoscopy to evaluate the presence or absence, the location and anatomy of a testicle that cannot be felt (non-palpable). A tiny incision is made at the belly button to allow the special camera to enter the abdomen. We can then examine the entire abdominal cavity and see if a testis is present.

Laparoscopic Orchidopexy
Once the testis is noted to be intra-abdominal on diagnostic laparoscopy, two additional laparoscopic ports can be placed through small incisions to allow us to perform the surgery and place the testis in the scrotum.

Inaccuracy of Other Tests to Locate a Testis
X-ray studies including CT scans, MRI scans, and ultrasounds are not 100% reliable for accurately identifying the presence or absence of the testis. Laparoscopy allows the surgeon to definitively determine the presence and location of the testicle. Eighty percent of patients who present with a nonpalpable testis will have some form of testicular tissue found during exploration. Sometimes the testis will be found in the groin region and a standard orchidopexy can be performed. Patients with a true intra-abdominal testis can have orchidopexy performed with laparoscopic techniques. Some patients are found not to have a testis, and no further treatment or intervention is needed.

Contraindications to Laparoscopy
There are some conditions such as extremely numerous and dense bowel adhesions that would make laparoscopy difficult. If this is the case, the surgeon may sometimes prefer to perform the surgery with standard open techniques.

Preoperative Preparation
No preoperative preparation is necessary for laparoscopic orchidopexy other than that which would be performed for routine surgery.

Laparoscopic (Robotic) Pyeloplasty (for obstruction)
Laparoscopic repair of UPJ obstruction allows the surgeon to perform the procedure through three or four very small incisions. We use specialized laparoscopic instruments through these small incisions to remove the blocked section and sew the drainage system back together. We sometimes use the DaVinci robot to perform this procedure. We will leave a soft drainage tube coming out of the skin. We may also leave a catheter in the bladder or the kidney. These tubes may all be removed before your child leaves the hospital or left in place until he/she returns to the office. Once they are removed, your child can bathe or shower. All of the stitches dissolve on their own.

We have performed numerous laparoscopic/robotic pyeloplasties with success rates that rival the open surgical technique. Children older than 10 years of age may benefit from the laparoscopic/robotic approach to minimize the size of the incision.

Laparoscopic Varicocele Surgery
The goal of varicocele surgery is to tie off the abnormally dilated veins that allow blood warmed to body temperature to drain into the dilated testicular veins. After the veins are blocked, the blood is unable to back flow into the testicle. This procedure can be performed through an open incision in the lower abdomen or laparoscopically. The laparoscopic varicocelectomy duplicates the open procedure in a minimally invasive approach. We perform the laparoscopic approach through 3 tiny (5mm) incisions. Tiny laparoscopic instruments are passed through the incisions to identify and repair the varicocele. Pain and recovery time is reduced using laparoscopic techniques. The success rate of this approach is > 97% which is equal to the open procedure. Laparoscopic Nephrectomy/Partial Nephrectomy When a child has a badly functioning kidney, we can remove it laparoscopically. A small incision is made in the umbilicus (belly button) and a small laparoscopic camera is inserted in to the abdomen. Two or three other tiny openings along the abdominal wall are made to place the other laparoscopic instruments. The kidney can then be removed through the umbilical opening, avoiding a large visible incision. Indications for nephrectomy include large kidneys, non-functioning kidney secondary to severe vesicoureteral reflux, or congenital UPJ obstruction