Beaumont Children's pediatric urology experts are highly skilled in using minimally invasive and robotic techniques to treat urological problems in children and teens. The goals of laparoscopic procedures are to minimize postoperative pain, allow for a more rapid return to normal activities, and decrease the length of the hospital stay. The smaller incisions also allow a better cosmetic result.
Diagnostic Laparoscopy for Undescended Testicle
We use laparoscopy to determine whether a testicle is present or absent when it cannot be felt in the scrotum. Laparoscopy can also help us find the location and anatomy of the testicle. During diagnostic laparoscopy, surgeons make a small incision near the belly button, which allows a tiny camera to enter the abdominal cavity. Then, with the help of the camera, we can examine the entire abdominal cavity and look for a testicle.
Laparoscopic Orchidopexy for Undescended Testicle
If we can see a testicle inside the abdomen during diagnostic laparoscopy, we can perform orchidopexy using laparoscopic techniques as well. We create two additional incisions so we can put the surgical tools inside, and we can then surgically move the testicle from the abdomen to the scrotum.
Inaccuracy of Other Tests to Locate a Testis
Imaging tests, such as X-ray, CT scans, MRIs, and ultrasounds, are not always reliable when looking for a testicle within the abdomen. Laparoscopy, on the other hand, allows surgeons to determine with 100% certainty whether there is a testicle within the abdomen and, if there is, where it is located. Eighty percent of patients whose testis cannot be found upon physical examination will have some form of testicular tissue outside of the scrotum found during laparoscopic exploration. Sometimes a patient’s testis will be found in the groin area. In that case, the surgeon can perform a standard orchidopexy. Patients who have a true intra-abdominal testis can have a laparoscopic orchidopexy. Sometimes, we find that patients do not have the missing testis. In that case, no further treatment is necessary.
Contraindications to Laparoscopy
Some conditions can make laparoscopy difficult, such as bowel adhesions that are numerous and dense. In this case, a surgeon may prefer to perform a traditional open procedure.
The only preoperative preparation required for laparoscopic orchidopexy is the standard preoperative procedures that every patient having routine surgery undergoes. There is no need for extra preparation.
Laparoscopic (Robotic) Pyeloplasty for Obstruction
Laparoscopic repair of ureteropelvic junction (UPJ) obstruction involves three or four tiny incisions through which the obstruction can be repaired. At Beaumont, we use specialized laparoscopic instruments to remove the blockage and stitch the drainage system back together. When possible, we use a DaVinci robot for the procedure. After surgery, we leave a soft drainage tube in the body that comes out through the skin. We may also leave a catheter in the bladder or the kidney. Your child’s doctor may choose to remove these tubes before your child leaves the hospital, or they may be left in place until the follow-up office visit. Once the tubes are removed, your child can take a shower or bath. The stitches are dissolvable and do not need to be removed.
At Beaumont, our pediatric urologists have performed many laparoscopic/robotic pyeloplasties, and our success rates are very similar to surgeries using the open or traditional techniques. Children who are older than 10 may benefit from the smaller incisions used with the laparoscopic/robotic approach.
Laparoscopic Varicocele Surgery
Varicocele surgery is performed to tie off the abnormal veins in the testicle(s) so blood can now flow backward into the testicle. This procedure can be done using open surgery, or it can be done using laparoscopic techniques. The laparoscopic varicocelectomy is virtually the same as the open procedure, however it is done using a minimally invasive approach. Instead of creating a larger incision in the abdomen, we use three tiny incisions (about 5mm each) to access and repair the varicocele. Some of the benefits of laparoscopic varicocelectomy are reduced pain and decreased recovery time. The success rate is greater than 97%, which is equal to the traditional open procedure.
Laparoscopic Nephrectomy/Partial Nephrectomy
When a child has a kidney that isn’t functioning well, we can remove it partially or completely using a laparoscopic surgical technique. During the procedure, the surgeon makes a small incision in the belly button and inserts a tiny camera into the abdomen. Then the surgeon makes two or three additional small incisions along the abdominal wall to place the other surgical instruments. The surgeon can remove the kidney (or part of the kidney) through the umbilical opening (the belly button), which means there won’t be a large, visible incision. Nephrectomies are often necessary for enlarged kidneys, congenital UPJ obstruction, and non-functioning kidneys secondary to vesicoureteral reflux.