According to online dictionaries, ENDOUROLOGY is “the branch of urologic surgery concerned with closed procedures for visualizing or manipulating the urinary tract.” But what exactly is that?
Pronounced: endo-you-rah-logy, Endourology is a subspecialty branch of urology in which small instruments and special cameras are used perform surgery on the urinary tract. Urologists may choose to obtain additional training by doing a fellowship in this area. This field started with the treatment of prostatic enlargement where a new procedure in the mid 20th century called TRANSURETHRAL RESECTION OF PROSTATE (TURP) revolutionized the field. Soon after, treatment of small bladder tumors followed. In the ensuing years, these techniques were used to investigate and treat kidney stones. These leaps of surgical improvement in treating kidney stones came about with much thanks to technologies which allowed for production of smaller and more powerful optics and scopes in conjunction with fiber optics which allowed delivery of better light with smaller instruments. Soon, instead of removing stones from the ureter and kidney by making large open incisions, small scopes were used to treat these stones with much less morbidity.
In the early 1980’s the treatment of kidney stones experienced its first paradigm shift, with the use of the SHOCKWAVE LITHOTRIPSY, where sound waves were used to break up stones in the kidney and ureter. Soon after, in 1991 with advances in laparoscopic surgery, the first laparoscopic nephrectomy was performed, during which a kidney was removed using small instruments and cameras inserted into the abdomen through small key hole incisions.
Since then, laparoscopy has enabled treatment of various urologic diseases, as it has enjoyed improvements of technology and equipment. But as with everything else, there have been improvements on doing surgery through small holes! The latest method of performing surgery is using the da Vinci surgical system. Briefly stated, this robotic surgical system, enables the surgeon to control small instruments that are inserted through small key-hole incisions into the abdominal cavity. The difference between these robotic instruments and traditional laparoscopic ones is that the robotic instruments can mimic all 8 degrees of freedom and movement that the surgeon’s wrist can produce, all inside the patient. In a way, the robot allows the surgeon to have his hand in the body, without actually having the large incisions which would be needed to accomplish that. The robot also has special cameras which restore a 3D image for the patient, which is more realistic than the image available in most traditional laparoscopic settings.
In urology, the da Vinci surgical system is most commonly used to perform radical prostatectomy and partial nephrectomy for the treatment of prostate cancer and kidney cancer respectively. Please read more about these topics by clicking on the links.
Training in endourology, is an integral part of all current urology residency programs. New urology graduates are proficient in employing these techniques, and are able to treat kidney stones through small instruments, where 30 years ago, a large incision would be required. Same applies to the treatment of prostate cancer, where for example most urology graduates from 30 years ago today still use the traditional open surgical technique to remove the prostate, most graduates today would approach this surgery with the robot. Please more about da Vinci Robot Assisted Prostatectomy by clicking here.