Laparoscopic reconstructive urology.

Abstract

PURPOSE: Although laparoscopy has emerged as a feasible and effective alternative for a majority of open ablative abdominopelvic urological procedures, minimally invasive reconstruction has come to the forefront only recently. We present the current state of the art of laparoscopic reconstructive urology. MATERIALS AND METHODS: We conducted an extensive MEDLINE search of purely laparoscopic surgery from 1976 through 2002. Based on the results, we divide clinical reconstructive laparoscopic procedures into 2 broad categories-established and evolving. Each category is further classified according to the organ involved-adrenal and kidney, ureter (evolving only), bladder and prostate, and miscellaneous. Clinical procedures were considered established if our literature review revealed any report of more than 100 patients, or reports from at least 5 different centers greater than 20 patients each. If these criteria were not met, the procedure was considered clinically evolving. RESULTS: Laparoscopic reconstructive procedures such as pyeloplasty, radical prostatectomy and orchiopexy have achieved clinically established status. Laparoscopic bladder neck suspension, although reported in a significant number of cases, remains controversial because of its contradictory reported long-term success rates. Multiple additional laparoscopic reconstructive procedures have been performed in fewer numbers clinically with promising results. CONCLUSIONS: Until recently, urological laparoscopic surgery primarily focused on ablative procedures, with success. Building on this initial experience, advanced and sophisticated reconstructive procedures of considerable technical complexity are increasingly being performed purely laparoscopically. It is anticipated that in the future laparoscopic surgery could increasingly evolve into a preferred approach for advanced and sophisticated urological reconstruction.