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Keyhole Surgery & Laser Surgery

Keyhole Surgery (Laparascopic Surgery)

The trend in surgical techniques over the last two decades is towards developing the least invasive methods to perform surgical procedures.  It is believed this will cause less tissue destruction (less collateral damge) which will result in less pain and blood loss, more accurate surgery, a faster recovery and  better cosmetic results. Some organs like the upper part of the kidney and the prostate in the male pelvis are in difficult and hard to get to areas. In the past surgeons have had to make large incisions in the abdomen to be able to safely get their hands to these areas safely. Nowdays we can insert small instruments to operate with and cameras that are high definition, 3-D and with up to X10 magnification into these areas easily allowing surgery to be performed with more accuracy and less bleeding and pain.

Laparoscopy is a minimally invasive surgical procedure which utilizes several small incisions in the abdomen to insert a viewing instrument, the laparoscope, and tiny surgical instruments.  Laparoscopy is used to diagnose and treat a wide range of problems within the abdominal and pelvic cavities. It differs from traditional "open" surgery which utilizes one large incision to access the abdomen.

Laparoscopy is a procedure that enables your surgeon to look inside the abdominal and pelvic cavities to diagnose and treat a variety of abnormal conditions.  A laparoscope is a long, narrow telescope with a light source and video camera at the end. The scope is passed through a tiny incision into the abdomen where images from the camera are projected onto a large monitor for the surgeon to view the abdominopelvic cavity.  Laparoscopes have channels inside the scope enabling the surgeon to pass gas in and out to expand the viewing area or to insert tiny surgical instruments for treatment purposes. The surgical instruments used in operative laparoscopy are very small but appear much larger when viewed through a laparoscope.

Benefits of Laparoscopy versus Traditional (Open) Surgery:

  • Smaller incisions
  • Minimal soft tissue trauma
  • Less pain
  • Faster healing time
  • Lower infection rate
  • Less scarring
  • Less blood loss
  • Earlier mobilization
  • Usually performed as outpatient day surgery

Laser Surgery

Laser surgery involves using intense beams of light to accurately cut, burn, or destroy tissue. The term laser is an acronym for "light amplification by stimulated emission of radiation." Focused, intense beams of light treat tissues by heating the cells until they essentially break up or burst. 
Laser surgery is used for a variety of reasons:

  • Cosmetic purposes such as removing moles, tattoos, scars and blemishes, as well as treatment for wrinkles
  • Treatment purposes to remove tumors in various parts of the body or other diseased tissues
  • Close off blood vessels to reduce the risk of bleeding
  • Close off nerve endings to lessen pain post operatively
Urological Applications

Lasers have been used in Urology for many years, There are two main areas of use of lasers in Urology. Firstly the destruction of stones in the kidney, ureter and bladder are now routinely done woth lasers as they are very effective and safe and flexible allowing us to get into areas that were inaccessible previously. Laser destruction of stones is achieved with minimal trauma to the surrounding tissues.

Secondly, lasers are used to open up the prostate. Progressive enlargement of the prostate which happens typically as men age can squeeze the urethra causing a variety of symptoms. The prostate can be opened up with laser surgery or the traditional 'resection' (TURP). There are a number of lasers now that can peform this surgey (Greenlight laser and the Evolve laser). The benefits are again less trauma and a faster recovery but also that the laser can still be performed in patients that are on blood thinning medication. THis will lead to safer surgery for these patioents.

Kidney Function Tests

The main functions of the kidneys include

Excretory - Excretion of toxins, waste products, and drugs.

Regulatory - Control of the volume of body fluids and their concentration (electrolyte balance)

Endocrine - Production of hormones :  Erythropoietin- which stimulates the bone marrow to make red blood cells; Renin - which regulates blood pressure; Calcitriol - the active form of vitamin D, which helps maintain calcium for bones and for normal chemical balance in the body; and Prostaglandins - Prostaglandin E2 is a powerful vasodilator.

Metabolic - Metabolism of Vitamin D and small molecular weight proteins

If you have two healthy kidneys, you have 100 percent of your kidney function. Small declines in renal function may not cause a problem. Some people may be born with only one kidney or some may donate a kidney for transplantation to a family member or friend and these people are able to lead normal, healthy lives.

But many people with reduced renal function have a kidney disease that will get worse. You will have serious health problems if you have less than 25 percent of your renal function. If your renal function drops below 10 to 15 percent, you cannot live long without some form of renal replacement therapy - either dialysis or transplantation.

What medical tests detect kidney disease?

Because a person can have kidney disease without any symptoms, a doctor may first detect the condition through routine blood and urine tests. The National Kidney Foundation recommends three simple tests to screen for kidney disease: a blood pressure measurement, a spot check for protein or albumin in the urine, and a calculation of glomerular filtration rate (GFR) based on a serum creatinine measurement. Measuring urea nitrogen in the blood provides additional information.

Blood Pressure Measurement

High blood pressure can lead to kidney disease. It can also be a sign that the kidneys are already impaired. The only way to know whether a person's blood pressure is high is to have a health professional measure it with a blood pressure cuff. The result is expressed as two numbers. The top number, which is called the systolic pressure, represents the pressure in the blood vessels when the heart is beating. The bottom number, which is called the diastolic pressure, shows the pressure when the heart is resting between beats. A person's blood pressure is considered normal if it stays below 120/80, stated as "120 over 80." The NHLBI recommends that people with kidney disease use whatever therapy is necessary, including lifestyle changes and medicines, to keep their blood pressure below 130/80.

Microalbuminuria and Proteinuria

Healthy kidneys take wastes out of the blood but leave protein. Impaired kidneys may fail to separate a blood protein called albumin from the wastes. At first, only small amounts of albumin may leak into the urine, a condition known as microalbuminuria, a sign of deteriorating kidney function. As kidney function worsens, the amount of albumin and other proteins in the urine increases, and the condition is called proteinuria. A doctor may test for protein using a dipstick in a small sample of a person's urine taken in the doctor's office. The color of the dipstick indicates the presence or absence of proteinuria.

A more sensitive test for protein or albumin in the urine involves laboratory measurement and calculation of the protein-to-creatinine or albumin-to-creatinine ratio. Creatinine is a waste product in the blood created by the normal breakdown of muscle cells during activity. Healthy kidneys take creatinine out of the blood and put it into the urine to leave the body. When the kidneys are not working well, creatinine builds up in the blood.

The albumin-to-creatinine measurement should be used to detect kidney disease in people at high risk, especially those with diabetes or high blood pressure. If a person's first laboratory test shows high levels of protein, another test should be done 1 to 2 weeks later. If the second test also shows high levels of protein, the person has persistent proteinuria and should have additional tests to evaluate kidney function.

Glomerular Filtration Rate (GFR) Based on Creatinine Measurement

GFR is a calculation of how efficiently the kidneys are filtering wastes from the blood. A traditional GFR calculation requires an injection into the bloodstream of a substance that is later measured in a 24-hour urine collection. Recently, scientists found they could calculate GFR without an injection or urine collection. The new calculation - the eGFR - requires only a measurement of the creatinine in a blood sample.

In a laboratory, a person's blood is tested to see how many milligrams of creatinine are in one deciliter of blood (mg/dL). Creatinine levels in the blood can vary, and each laboratory has its own normal range, usually 0.6 to 1.2 mg/dL. A person whose creatinine level is only slightly above this range will probably not feel sick, but the elevation is a sign that the kidneys are not working at full strength. One formula for estimating kidney function equates a creatinine level of 1.7 mg/dL for most men and 1.4 mg/dL for most women to 50 percent of normal kidney function. But because creatinine values are so variable and can be affected by diet, a GFR calculation is more accurate for determining whether a person has reduced kidney function.

The eGFR calculation uses the patient's creatinine measurement along with age and values assigned for sex and race. Some medical laboratories may make the eGFR calculation when a creatinine value is measured and include it on the lab report. The National Kidney Foundation has determined different stages of CKD based on the value of the eGFR. Dialysis or transplantation is needed when the eGFR is less than 15 milliliters per minute (mL/min).

Blood Urea Nitrogen (BUN)

Blood carries protein to cells throughout the body. After the cells use the protein, the remaining waste product is returned to the blood as urea, a compound that contains nitrogen. Healthy kidneys take urea out of the blood and put it in the urine. If a person's kidneys are not working well, the urea will stay in the blood.

A deciliter of normal blood contains 7 to 20 milligrams of urea. If a person's BUN is more than 20 mg/dL, the kidneys may not be working at full strength. Other possible causes of an elevated BUN include dehydration and heart failure.

Additional Tests for Kidney Disease

If blood and urine tests indicate reduced kidney function, a doctor may recommend additional tests to help identify the cause of the problem.

Kidney imaging. Methods of kidney imaging - taking pictures of the kidneys - include ultrasound, computerized tomography (CT) scan, and magnetic resonance imaging (MRI). These tools are most helpful in finding unusual growths or blockages to the flow of urine.

Kidney biopsy. A doctor may want to examine a tiny piece of kidney tissue with a microscope. To obtain this tissue sample, the doctor will perform a kidney biopsy - a hospital procedure in which the doctor inserts a needle through the patient's skin into the back of the kidney. The needle retrieves a strand of tissue less than an inch long. For the procedure, the patient lies facedown on a table and receives a local anesthetic to numb the skin. The sample tissue will help the doctor identify problems at the cellular level.

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