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Innovative operational techniques

Innovations

1. 3D laparoscopy
Since the beginning of 2014 we have had state-of-the-art 3D equipment for laparoscopy. Our range of services has therefore expanded even further – although even previously we were able to offer the whole range of urological laparoscopy procedures. In particular, complicated partial renal resections and careful dissection in cases of radical prostatectomy, including nerve preservation, can be significantly optimised through this innovation and the indications for laparoscopic surgery have been expanded.

2. Laparoscopic kidney transplant from a living donor and autotransplantation
In patients with ureter strictures and functioning kidneys, ureter reconstruction is often necessary. In individual cases, for example after extended radiation treatment or following multiple surgical procedures, it is not possible to use the small bowel for reconstructing the ureter. In these cases, laparoscopic nephrectomy can be performed on the affected side, followed by autotransplantation of the kidney into the fossa iliaca. In analogy to living donor kidney transplantations with dialysis patients, the kidney is cooled, perfused and dissected immediately after hand-assisted removal from the situs. The subsequent autotransplantation into the fossa iliaca is conducted, with anastomosation of the renal vessels (usually onto the arteria and vena iliaca externa) as well as ureterocystoneostomy or pyelocystostomy, depending on the length of ureter available. 

3. Transurethral, bipolar enucleation of the prostate 
So far, open adenomectomy has been performed if the prostate was enlarged to a volume of approximately 100 ml or more. With bipolar transurethral enucleation it is also possible to remove such enlargements of the prostate gland via the urethra. First, a biopsy is performed on the enlarged gland tissue in the prostatic fossa, and it is then removed “bit by bit” as in the case of transurethral prostatic resection. In this way, the patient can avoid open surgery. Complications such as bleeding and transfusion are significantly less frequent. The stay in hospital is reduced by half. This operating method is even suitable for patients receiving anticoagulation agents.

4. Laparoscopic extraction of ureter, renal pelvis and renal calyx stones 
In particular in cases of large stones or when several/additional renal calyx stones are present, direct access to the renal pelvis using keyhole technology – combined with intraoperative flexible endoscopy - has advantages over the standard procedure: percutaneous nephrolitholapaxy (PNL).

5. Creation of a pyelovesical bypass 
Ureteral strictures can be caused by various disorders. If not treated, the resulting urine flow disturbances can lead to a decline in kidney function. The available treatments include both established ureter replacement procedures (ileal interposition) and other reconstructive operations. Ureter stents or percutaneous nephrostomies are used if there are contraindications for surgical correction. Owing to their side effects, these urinary diversions may partly restrict the quality of life and social competence of the patients.
As an alternative to this, our Clinic offers the use of a subcutaneous ureter prosthesis (pyelovesical bypass, Detour prosthesis) with curative and palliative intent. The Detour system, which consists of an internal silicon tube with open-pored Dacron sheathing, is permanently implanted under the skin as a so-called pyelovesical bypass. This technique has proven to be low-risk, with a favourable complication profile.

6. Laparoscopic surgery in children 
The high local resolution of modern 3D HD cameras offers particular advantages in this comparatively small surgical field – completely avoiding large skin incisions. Our young patients also benefit from this.
Keyhole surgery is standardly used for children in the surgical treatment of 
- pyeloureteric junction obstruction,
- full kidney removal,
- partial renal resection,
- varicocele surgery,
- search for an intra-abdominal testicle and
- orchidopexy (peeping testis).
In the treatment of vesicoureteral reflux, various parameters are used to decide whether to perform open surgery or a laparoscopic procedure.