Urological Minimally Invasive Procedures

Cryotherapy, or cold therapy, is a minimally invasive treatment that uses extremely cold temperatures to freeze and destroy cancer cells and tissue in the prostate with minimal side effects. Although this procedure is a relatively newer prostate cancer treatment and lacks studies to determine its long term effectiveness, cryotherapy has shown to be effective among selected patients who have failed previous radiation treatment or have recurring prostate cancer or localized tumors. Also, a portion of the prostate or the entire prostate can be treated to destroy the tumor.

Procedure Details

With cryotherapy, the patient is placed under general anesthesia. The surgeon uses ultrasound to accurately insert ultra-thin needles into the prostate gland through the perineum, the area that lies between the scrotum and anus. To protect the urethra from sub-zero temperatures, a warm saline solution flows through a catheter, and temperature monitors are placed around the prostate.

Once the needles are positioned, cold argon gas is infused into the needles, freezing the prostate gland and destroying the cancerous tissues. In most cases, this procedure is performed in an outpatient setting and takes up to one to two hours.

The department of urology is taking the lead in surgical innovation by pioneering new techniques for urologic surgery that leave little or no visible scar. One new form of surgery performed at Loma Linda University Health is Laparoendoscopic Single Site Surgery (also known as LESS).

In this technique a single, small incision is hidden in the folds of a patient’s belly button. Through this single incision even very large kidneys can be removed.

The department of urology is also performing single incision forms of surgery for selected kidney cancers and even to remove kidneys from patients who are donating kidneys to friends or relatives. Figure 4a shows the postoperative outcome and figure 4b shows the kidney removed for donation using a single incision.

In addition, the department of urology at Loma Linda University is working to develop new and improved ways to advance the boundaries of scarless surgery and to allow these procedures to be performed in a larger number of patients.

Hand assisted laparoscopy is a minimally invasive surgical procedure used for a variety of urologic purposes that can be performed with or without the da Vinci robotic surgical system. This procedure uses laparoscopic surgery techniques and allows a surgeon to have more options in the operating field, reducing complications and operating time.

Procedure Details

During the laparoscopic procedure, the patient is placed under general anesthesia and is fully asleep. The surgeon makes a small incision, usually in the abdomen, and a tube is inserted. CO₂ gas is pumped through the tube and inflates the abdomen, giving the surgeon increased visibility.

A laparoscope, the device that allows the surgeon to see inside the body, is also inserted. In hand assisted laparoscopy, another, slightly larger, incision is made, allowing the surgeon to directly influence the surgical process and remove organs or other tissue that would be too large to fit through the tiny incisions made in strictly laparoscopic surgery.

BPH, or benign prostate hyperplasia, is not prostate cancer but has some of the same symptoms of prostate cancer. Nearly all men eventually experience some degree of prostate growth and as the prostate enlarges, it can interfere with the bladder's ability to empty itself. When a patient at Loma Linda University Health is diagnosed with BPH, a urologist may recommend a variety of treatments, including minimally invasive procedure options.

Procedure Details

Microwave BPH therapy, also known as transurethral microwave thermo-therapy (TUMT), uses heat to destroy a portion of the enlarged prostate surrounding the urethra. This minimally invasive procedure allows the patient to urinate more freely by making the urethra larger as it passes through the prostate. Microwave BPH therapy is an outpatient procedure and does not involve overnight hospitalization.

Percutaneous nephrostolithotomy (PCNL) is a common minimally invasive procedure that uses a needle and an endoscope passed through the skin and into the kidney to either remove (lithotomy) or break up (lithotripsy) the stone.

Procedure Details

In a percutaneous nephrostolithotomy, the doctor makes a small puncture in the patient’s back to create a tract directly on the kidney to the stone. Through the tract, the doctor inserts a fiber optic telescope called a nephroscope to either manually remove the stone or break it up into tiny pieces using a laser, ultrasound probe or pneumatic device prior to extraction.

After the procedure, a temporary nephrostomy tube is placed in the kidney and another tube called a stent is placed in the ureter to prevent it from swelling shut and to drain the urine from the kidney. Once the kidney is healed and all the stones have been eliminated, the tubes are removed.

Although many kidney stones pass through the urinary tract without medical intervention, some cases require treatment from a medical professional. At Loma Linda University Health, we provide shock wave and laser lithotripsy, minimally invasive procedures that break up kidney stones.

Procedure Details

Once the stones are detected in x-ray or ultrasound images, high energy sound waves or lasers are directed toward the patient's kidney stone and break it into small pieces. These pieces can usually pass unassisted through the urinary tract, but sometimes a small stint is inserted to help the pieces pass through.

A mild sedative or painkiller is provided to the patient as shock wave and laser lithotripsy can cause some discomfort. The procedure usually takes approximately 45 minutes to one hour and does not require an overnight hospital stay.

If a patient has a stone lodged in the ureter, Loma Linda University Health's urologists may recommend a ureteroscopy. The ureter is the tube that carries urine from the kidneys, to the bladder and in a ureteroscopy, the surgeon passes a thin viewing instrument called a ureteroscopy through the urethra and into the bladder.

The surgeon then moves the scope up into the ureter. This allows the surgeon to see the small stone or stones that have passed from the kidneys and become stuck in the ureter. While the passing of stones, particularly when they become lodged in a narrow ureter or urethra can be extremely painful, this procedure is performed when the patient is fully asleep under general anesthesia. There are no incisions made during a ureteroscopy.

Procedure Details

Once the afflicting stones have been located, the surgeon will use laser energy to break up the stones. They will then pass through the urethra. A small tube called a stent will be left in the ureter for up to two weeks to enhance healing. Ureteroscopy is an outpatient procedure at Loma Linda University Health and typically does not require overnight hospitalization.

For patients with bladder cancer, a cystectomy, or the surgical removal of part of or the whole bladder, may be recommended. Surgeons most often recommend a cystectomy when the cancer has spread to the bladder wall, as in stage II and stage III cancer, or when other treatments have proved ineffective.

Procedure Types

• Radical Cystectomy – In a radical cystectomy, the entire bladder, nearby lymph nodes and part of the urethra are typically removed. At Loma Linda University Health, our surgeons can utilize robotic assisted surgery technology, thus offering a less invasive procedure while amplifying the level of precision we can offer our patients. After removing the bladder, the surgeon will create a urinary diversion. For some patients, this will include the creation of a new bladder from a portion of the colon or intestine that allows normal urination through the urethra.
• Partial Cystectomy – This procedure involves only removing part of the bladder, then following up the surgery with radiation and chemotherapy.

A nephrectomy, or kidney removal surgery, is one of the most effective options for patients whose cancer is confined to their kidneys. This surgical procedure is done while the patient is asleep under general anesthesia and involves either one large or four small incisions in the abdomen and flank area.

Procedure Types

There are four main types of nephrectomies:

• Open Radical Nephrectomy – Radical nephrectomy is an open surgery which requires a large cut in the abdomen. This procedure is most often chosen when the patient has a large renal mass or advanced disease that is concentrated in the kidney.
• Laparoscopic Radical Nephrectomy – In a laparoscopic nephrectomy, the surgeon is able to remove the kidney through three or four small incisions. This procedure is less invasive and typically results in less pain and a quicker return to normal activities after surgery.
• Partial Nephrectomy – The partial removal of the kidney can be an extremely effective procedure for patients with small amounts of cancerous tissue, bilateral tumors, only one kidney or preexisting kidney problems.
• Laparoscopic Partial Nephrectomy – For select patients, the minimally invasive laparoscopic partial nephrectomy can be the best choice as it requires only tiny incisions, allowing the patient to recover more quickly and with typically less pain.

A prostatectomy, or the surgical removal of the prostate, is one of the most effective and common ways of treating prostate cancer and is performed while the patient is asleep under general anesthesia. The surgery also removes the nearby seminal glands and may remove the lymph nodes to check the spread of the cancer. Surgical intervention may also be required to fix urinary problems that result from a cancerous tumor putting pressure on the urethra.

Procedure Types

There are two main types of prostatectomy surgeries, traditional and minimally invasive. While no procedure can completely guarantee the removal of cancer, leading experts agree that robotic prostatectomies offer the greatest chance for a long-term cure.

• Open Prostatectomy – This surgery removes the prostate and any nearby tissue containing cancer through an incision in the lower abdomen.
• Robotic Prostatectomy – In this procedure, a surgeon uses the da Vinci® surgical system to perform minimally invasive surgery to remove the prostate and any cancerous tissue through tiny incisions in the abdomen or the perineum. Leveraging human control of technology, the da Vinci surgical system enhances the surgeon’s visual field and surgical precision. Ultimately, this procedure allows for fewer risks of side effects and a much faster recovery time compared to conventional, open prostatectomies.

Loma Linda University Health is the Inland Empire’s leader in robotic prostatectomies with the area’s most experience in performing this minimally invasive procedure. We also have the largest, most comprehensive prostate cancer program in the region, and one of our urologists would be happy to sit down with you and answer any questions you may have about the procedure.

Men also benefit from the Loma Linda University Center for Health Promotion’s lifestyle and wellness program that ensures men maintain a high quality of life while undergoing cancer treatment for prostate cancer, specifically. Learn more about the Center for Health Promotion today!