Laparoscopic Surgery

Monterey Bay Urology Associates are experts in laparoscopic urological surgery. Laparoscopy is major surgery done through multiple small openings instead of a large, painful abdominal incision. MBUA urologists were the first urologists in the Monterey Bay area to perform laparoscopic nephrectomy, robot-assisted laparoscopic prostate surgery, laparoscopic cryosurgery for kidney tumors, and many other types of urological surgery.

Our urologists were instrumental in bringing the da Vinci Surgical System to Dominican Santa Cruz Hospital and utilize the newest technology to perform robot-assisted laparoscopic surgery. Our urologic surgeons have undergone extensive additional training in order to bring these state-of-the-art techniques to the local medical community, and our experience ensures that patients will get the best possible outcomes from their surgery. Patients can be confident that they can receive the same state-of-the-art care that they would seek at a university hospital in their own home town and with the personal care of thier own local urologist.

What is laparoscopy?

laparoscopic nephrectomy

laparoscopic nephrectomy is a major surgery performed through small incisions and viewed through a telescope and camera.

Laparoscopy is abdominal surgery that is performed through small incisions using telescopes to see the internal organs and long instruments to perform the surgery. Laparoscopy is an alternative to traditional open abdominal surgery in which a larger incision is made and the surgeon's hands are placed inside the abdominal cavity. Laparoscopy is much less invasive than traditional open surgery and offers patients less post-operative pain and a faster recovery. Laparoscopy is the standard of care for many types of surgery, including gall bladder surgery, kidney surgery, stomach surgery or gastric bypass, hernia surgery, and many others. Laparoscopy is the now the standard for surgery on the kidney, but urologists with additional training and expertise are able to offer laparoscopic surgery for an expanding number of urologic conditions. Monterey Bay Urology Associates were the first urologists in Santa Cruz to perform major laparoscopic surgery, and we have been performing robot-assisted laparoscopic prostate cancer surgery since January 2003.

Laparoscopic Cancer surgery on the kidney

Laparoscopy is now the standard surgery for most cancers of the kidney. Most kidney tumors larger than 4 cm in size (about 2 inches) require removal of the entire kidney in order to be sure that all of the cancer is removed. Removal of the entire kidney used to require a large abdominal incision, but laparoscopic surgery is now the standard of care for kidney cancer surgery. We use a technique which uses 4 abdominal ports placed through small skin incisions. After the kidney is removed from its attachments a small, transverse incision is made above the pubic bone and the kidney is removed intact. The lower abdominal incision is just large enough to remove the kidney and has a small amount of postoperative pain. Most patients are able to eat the next day and able to go home in 1-2 days, and resume normal physical activity in 2 weeks. The recovery is much faster and easier than traditional, open surgery, after which patients are usually in the hospital 5-7 days and take 6 weeks or more to resume normal activity. Some urologists use a technique called hand-assisted laparoscopy, in which a 4 inch incision is made above the belly button and a hand placed into the abdomen to help with the surgery. The kidney can be removed through this incision, but the type of upper abdominal incision is much more painful than a lower abdominal incision and leaves a much more obvious scar. We believe that this defeats some of the benefits of laparoscopy, and we favor the approach described above.

The surgical treatment of smaller kidney tumors (<4 cm) has been controversial in the past, and many urologists will still recommend removal of the entire kidney. There is convincing medical evidence that shows that removal of the entire kidney is not necessary for most small kidney tumors, and total removal of the kidney may actually shorten life expectancy. We recommend robot-assisted laparoscopic partial nephrectomy using the da Vinci Surgical System to perform minimally-invasive surgery to remove just the tumor and not the entire kidney. Our urologists were the first on the Central Coast to have the additional training to perform this state-of-the-art surgery.

cryoablation of a small kidney tumor

cryoablation of a small kidney tumor

Laparocopic Cryosurgery for small kidney tumors

Smaller tumors of the kidney can be treated with removal of the tumor instead of complete kidney removal (called laparoscopic partial nephrectomy), or with a less invasive treatment called laparoscopic cryosurgery. Laparoscopic cryosurgery freezes the kidney tumor and kills the cancer cells without removing the rest of the kidney that is healthy. This is a very effective treatment for smaller kidney tumors or tumors in a solitary kidney. The cure rates with this less invasive treatment are as high as with traditional surgery and patients recover faster with minimal change in their kidney function. Many patients who already have decreased kidney function are better treated with cryosurgery. Your urologist can help decide if cryosurgery or partial nephrectomy is the best approach for your kidney tumor.

Laparoscopic Radical Prostatectomy for Prostate Cancer

da Vinci robot-assisted aparoscopic prostatectomy is rapidly becoming the standard for prostate cancer surgery. Dr. Benjamin and Dr. Rosen have been performing robot-assisted laparoscopic prostate surgery since January 2003 and were the first urologists on the Central Coast to perform this operation with the state-of-the-art da Vinci Surgical System. We have found that patients recover faster than with open prostate surgery, and have equal or better results in curing the cancer and recovering urinary and sexual function. Click here to get more information about this procedure.

Laparoscopic Pyeloplasty for Uretero-Pelvic Junction obstruction

Ureteropelvic Junction (UPJ) obstruction is a partial blockage of the ureter, the muscular tube that carries the urine from the kidney to the bladder. It can occur at all ages, from young children to adults. The standard operation is done through the flank and has a 95% chance or curing the blockage permanently. Most patients are in the hospital for 3-5 days and have pain for at least 6 weeks after surgery. MBUA urologists perform da Vinci robot-assisted laparoscopic surgery to correct UPJ obstruction, an operation called laparoscopic pyeloplasty. Laparoscopic pyeloplasty corrects the problem equally as well as open surgery, and most patients can leave the hospital in one day and are back to normal activities within 2 weeks.

Laparoscopic Varicocele Surgery

Varicoceles are dilated veins in the scrotum that drain blood from the testes. Varicoceles can cause pain or low sperm count. The traditional surgery involves a small incision in the groin, similar to a hernia incision. The pain level from the open varicocele is moderate, but patients who have surgery in both groins on the same day will have significant pain for the first week after surgery and are not able to exercise or do physical activity for several weeks after surgery. Laparoscopic varicocele surgery is an outpatient procedure done through 3 small holes in the abdominal wall. Most patients are back to normal activity within a few days of surgery.