Lumbar fossa (flank) surgery
The deep situation of the kidney in the lumbar fossa, under the last ribs, makes all traditional approaches precise large incisions for good surgical access. Here the advantages of laparoscopy are uncontested, being currently on debate if laparoscopy should be not an option but a must for most renal surgery. That is the fact today for the surgery of the adrenal gland, situated on top of the kidneys, which, due to their small size, may be extracted through a trocar site, without any extra incision.
Surgery of the adrenal gland (adrenalectomy), located on top of each kidney, is, together with cholecystectomy, one of the locations where laparoscopic approach is widely accepted. Its deep location together with its small size make the laparoscopic approach a great advantage for surgery recovering, being woundless other than the trocar incisions.
Excision of the stenotic fragment of urinary tract (pyeloplasty) with wide reconstruction is the essential to uretheropielic junction (UPJ) syndrome. Open surgery of the UPJ syndrome has the same inconvenient as renal surgery, the need for a flank incision. Laparoscopic approach allows for a precise uretheric and pyelic dissection with the excision of the stenotic segment and an end-to-end anastomosis equivalent to standard treatment without its disadvantages.
Bladder extirpation (cystectomy) in case of vesical tumours (bladder cancer) that may need this radical treatment can be done by a laparoscopic approach. It is a complex procedure and its indication cannot be generalized. It is only undergone by experienced laparoscopy surgeons. Main advantages of this technique are less bleeding and shorter time to recover bowel movement (to pass air). It requires an abdominal incision (laparotomy) to extract the large surgical specimen which allows for the urinary tract reconstruction.