Treating urological conditions with MIS

The surgical treatment of urological diseases in the urinary and male reproductive tracts, such as for kidney, prostate, and bladder conditions, has traditionally required large abdominal incisions and long hospital stays.

Today, however, minimally invasive surgeries (MIS), often referred to as laparoscopic or keyhole surgery, have revolutionised medicine and are replacing the need for conventional open surgeries. This has enabled the less invasive treatment of most conditions, simply by using several tiny incisions on the abdomen.

As a result, patients experience better recovery outcomes, such as less pain and minimal scarring.

“Due to the smaller incisions and quick post-op recovery, the risks of developing infections and the need for post-op pain medications are significantly reduced as well,” said Dr Poh Beow Kiong, an urologist practising at Gleneagles Hospital and Mount Elizabeth Novena Hospital in Singapore.

With MIS, patients are able to return home in about two days, he said, compared to traditional surgeries that could take weeks to recover from. Patients are also able to return to work and their normal activities, including mild exercise such as brisk walking, much sooner than with open surgeries.


MIS surgery on kidney tumours highlights its benefits

A nephrectomy has long been the only way to remove kidney tumours to determine whether they are benign or cancerous. The procedure is usually performed through a large open incision in order to remove the entire organ or a part of it.

“Using traditional biopsies to remove a part of the tumour tissue and assess the cancerous cells, just as it’s done with breast cancers, is not applicable for kidney tumours,” explained Dr Poh. “This is because a kidney tumour is usually protected by a capsule, which when punctured could spread the cancerous cells to other parts of the body. This is a risk surgeons cannot take.”

But a conventional nephrectomy also has its downsides. “When the tumour from the extracted kidney or part of it is found to be benign, in which case it could have been treated without surgery, then a patient would have lost a good organ unnecessarily,” he explained.

This is where the advancement of laparoscopic partial nephrectomy comes in as a better alternative to treating kidney tumours as big as six centimetres. This procedure is able to completely remove tumour tissues while preserving the non-cancerous, normal functioning part of the kidney, all through a small incision.

“The technology affords excellent cancer control. It is advanced enough to remove a tumour alone, while sparing the normal functioning portion of the kidney without compromising on cancer cure,” said Dr Poh, “These treatments offer cure rates equal to traditional open surgery but with significant advantages.”

On top of minimal pain and scarring, patients would not experience any ‘heartache’ in losing a good organ if the tumour was found to be benign, he said.

According to Dr Poh, however, if a tumour were bigger than six centimetres, then a radical laparoscopic nephrectomy, which removes the entire organ, would be called for.

“Only in cases where the cancer cells have spread to the IVC (inferior vena cava), the largest vein in the human body, will conventional open surgery be considered,” he said.


Robotic surgery for prostate cancer

In the urology field, some laparoscopic procedures are being replaced by robotic surgeries, which involves manipulating surgical instruments attached to a robotic arm, using a console.

While both robotic and laparoscopic surgeries provide the advantages of faster recovery, less scarring and blood loss, and reduced risks of infections as well as fewer post-op meds than traditional open surgery, robot-assisted surgery is even more suitable in certain cases.

For example, most surgeons prefer performing robotic surgeries for a prostatectomy, a procedure used to treat prostate cancer by removing the infected cancerous tissues from the organ.

With the use of a high-resolution camera, micro-surgical instruments, and a full 360-degree motion of the robotic arm, this technique is best in confined spaces with limited movement range and vision, like in the deep cavities of a male’s pelvis, explained Dr Poh.


Not all types of prostate cancers require surgery

“Our understanding of prostate cancer has changed over the past five to 10 years because certain types of benign tumours may not require such invasive treatments,” said Dr Poh. “It is easy to treat a tumour through surgery, but it is a challenge to find out if it is benign or cancerous without surgery.”

This is because some of the factors that affect the decision on whether to undergo a prostatectomy include cell type, grade of the disease, and a patient’s age, as well as general health. A holistic assessment and active surveillance of the cancer is also required.



Dr Poh Beow Kiong is an urologist practising in Gleneagles Hospital and Mount Elizabeth Novena Hospital in Singapore. He specialises in laparoscopic or minimally invasive surgery and endourology, a minimally invasive treatment for kidney stones.