We cure mainly on adrenal gland, kidney, bladder, testis at the urology department. In addition, we go over to dysuria, Urinary stone, woman urologic disease (urinary incontinence, pelvic organ prolapse), male infertility, inborn character disease, many divergences including renal transplant as well as malignant tumor.
We learn from "examining sick person without examining disease" that it is mind of-based study of hospital at the Jikei University School of Medicine urology department and provide treatment suitable for each one of patient based on latest knowledge and evidence again.
We perform treatment-free active surveillance, operation, radiation therapy, medical care that we talk about treatment strategy with patient while many and are understood of choice including hormonal therapy for prostate cancer in particular. Seed implantation is introduced for the first time in 2003, and we achieve the treatment results more than 1,000 to date, and radiation therapy is facility of Japanese, leading. There are few cases that laparoscopic surgery is introduced by operation in 2004, and perform an operation, and shifted and is operated on nearly 100 patients every year. Changes of representative cure are as follows.
Mainly on laparoscopic surgery, we provide treatment that is low involvement. We perform operation of approximately 90% with laparoscope by operations such as adrenal gland, kidney, the prostate, bladder in this hospital.
Laparoscopic surgery is becoming spread operation method nationwide. We inject carbon dioxide in abdominal cavity and make a small hole through the abdomen and are operated on using exclusive instrument. However, various kinds of apparatuses and appliance are required for technique and knowledge, laparoscopic surgery which are higher than conventional open surgery.
In we Jikei University School of Medicine, it is enforcing this method for various diseases now in the first on the list at affiliated hospital.
- ●There is little bleeding
- Because venous bleeding is controlled, there are fewer amounts of bleeding than open surgery, and it is said to be unlikely to be blood transfusion by pneumoperitoneum pressure.
- ●Wound is small
- We cut approximately 3-5 places of eyelets from 5mm to around 15mm open and are operated on.
- ●Postoperative recovery is early
- There are few postoperative pains in small scar, and early getting up is possible.
- Field of vision that spread with endoscope (camera) more is got, and polite, safe operation is possible.
- We share the same field of vision with all the operation teams and are useful for anatomical understanding and technical improvement.
- Good teamwork by person in charge of endoscope projecting operation field with assistant, endoscope to assist for operation in practiced hand (leader), forceps or aspirating tube (sukopisuto) is demanded.
- We open approximately 3-5 places of eyelets from 5mm to around 15mm and insert fatty car to put forceps (surgical instrument) in and out freely. During operation, we perform pneumoperitoneum of the abdominal cavity with carbon dioxide to operate forceps and endoscope more safely. Venous bleeding is held in check by pneumoperitoneum of carbon dioxide. Finally we extract organ which we removed surgically than eyelet and are finished.
Laparoscope has superior good point in this way, but may wake up complications that we show below. In addition, it may shift to open surgery when operation is difficult and when the enteric adhesion is high, problem occurred to accomplish operation safely.
- 1) Subcutaneous emphysema
- It takes place by carbon dioxide leaking subcutaneously from the fatty car episode neighborhood. Most are absorbed naturally in a few days and are relieved.
- 2) Gas embolus
- Carbon dioxide which we used for pneumoperitoneum enters blood vessel and is in condition to be clogged up to pulmonary artery.
It is very rare, but becomes serious complications.
- 3) Recurrence, metastasis to fatty car part
- When we extract organ which we removed surgically, recurrence, metastasis may be caused to site where we inserted fatty car in.
There is report with 0.01%, and frequency in urology department domain is said to be very rare.
In addition, complications that even open surgery happens include bleeding, the other organs damage, postoperative ileus, wound hernia, postoperative pulmonary embolism.
- ●Renal cancer
- We choose method by size, part of tumor. Generally, about tumor which is not located in renal pedicle part people (place with renal vein correcting bloodstream to artery, heart performing nutrient of kidney) in tumor diameter 4cm or less, we perform positively laparoscopic Partial nephrectomy. We perform laparoscopic nephrectomy evisceration about tumor of 4-7cm size.
- ●Renal pelvic carcinoma, ureter cancer
- General method is nephroureterctomy. We perform nephrectomy by laparoscopic maneuver in this hospital.
- ●Bladder cancer
- Except advanced case which infiltrated pericystic organ, we perform laparoscopic bladder total extirpation. Urinary diversion (method to change urinary exit) goes to the abdominal region by small incision of 5-7cm like figure.
- ●Prostate cancer
- Generally, except advanced case which infiltrated prostatic people, we perform laparoscopic prostatic total extirpation.
- ●Adrenal gland tumor
- We judge adaptation by size. Generally, we perform operations with laparoscope to 4-5cm size.
- ●Ureteropelvic junction stenosis
- For adult case, we perform Laparoscopic pyeloplasty.
As for the laparoscopic surgery, high technique and knowledge are found as well as open surgery. In this hospital, we receive examination of urinary organ laparoscope technology authorization system which Japanese urinary organ endoscope society established and, with doctor that technique about laparoscopic surgery in urology department domain was authorized, perform all laparoscopic surgery. 14 people are registered at urinary organ laparoscopic technical authorized medicine now including affiliated hospital.
Furthermore, we see mirror, and lower operation training course examination is made mandatory by doctor concerned with laparoscopic surgery to perform safer operations in the Jikei University School of Medicine, and it is admitted that only passer participates in real operation.