 What is minimally invasive surgery?
It has always been the role and duty of the physician to cure disease. However, historically, the treatment of a disease was sometimes as traumatic to the patient as the disease itself.
As surgery and the technologies associated with surgery have evolved and improved, increasing emphasis has been placed on treating disease while minimizing the trauma to the patient. The concept of surgically curing a disease with the least “traumatic” or “invasive” approach engendered the field of minimally invasive surgery.
The typical terms and nomenclature of invasive and minimally invasive surgery are defined below:
Laparoscopic Surgery – Laparoscopic surgery mimics the techniques of open surgery (surgery done with a large incision), but no large incision is required. Instead, small incisions approximately ½ inch (1cm) in size are created. Body spaces are gently expanded with inert gas and a small camera is inserted into the body. Small instruments can then be used to treat disease without the large incision associated with open surgery.
Robotic Laparoscopic Surgery - Robotic laparoscopic surgery is identical to laparoscopy in that the technique requires small incision instead of a large incision for access. In robotic surgery, the surgeon controls robotic arms which perform the procedure. Today, the only clinically available robot in existence is the DaVinci robot.
Endoscopic Surgery – Endoscopic surgery is a minimally invasive approach which, like laparoscopy, requires a small camera. However, the difference between laparoscopy and endoscopy is that the endoscope passes through an existing space such as the mouth, anus, or urethra. As such, endoscopy is less invasive than laparoscopy but is only applicable for some disease processes.
Open Surgery – Open surgery is not a minimally invasive technique as it requires larger incisions to access and eliminate the target disease. Open surgery refers to the original approach used by surgeons. Today, some disease processes still require open surgery to achieve the best outcome.
Ablation – Ablation consists of a series of minimally invasive technologies that have revolutionized the treatment of selected cancers (eg kidney and prostate). Unlike traditional surgical technique which cuts out disease, ablation destroys the disease where it exists, leaving surrounding normal tissues intact. For selected diseases such as prostate cancer and kidney cancer, ablation offers patients the opportunity for a very minimally invasive procedure. The Columbia University minimally invasive urology team uses cryoablation (disease freezing) in selected patients, and has one of the most extensive experiences in the world with this technology for both kidney and prostate cancer (LINK).
Watchful waiting / Active surveillance – Active surveillance, which is also known as watchful waiting, is the least invasive option for the management of a disease process. With this strategy, no active treatment is administered and the patient is observed for evidence of disease progression. Active surveillance is usually considered an option for some older patients with significant medical problems who have prostate cancer or kidney cancer. In prostate cancer, selected patients with less aggressive disease may consider this option, and blood levels of PSA are monitored. In kidney cancer, selected patients are observed and X-ray tests are performed to observe tumor growth.
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 How does minimally invasive surgery affect me, my disease, and my life?
When the goals of minimally invasive surgery are achieved, your disease is cured. Indeed, while minimally invasive surgery tries to minimize patient trauma, it should never compromise disease cure rates. This is our priority as we are frequently treating life-threatening diseases like cancer.
However, using minimally invasive surgical techniques, we are presently able to minimize trauma. By applying the minimally invasive concept there are several typical outcome alterations that significantly affect patient response.
- Bleeding is minimized. While there is absolutely no such thing as “bloodless surgery,” comparative studies demonstrate decreased blood loss with minimally invasive surgical approaches. This also means a decreased chance of blood transfusion and the associated risks of HIV and hepatitis transmission.
- Decreased pain. By minimizing trauma, minimally invasive surgery significantly decreases patient pain. This is an obvious benefit. While some people may agree with the statement, “No pain, no gain,” as minimally invasive surgeons we strongly do not agree.
- Hospital Stay is shortened. Due to the deceased bleeding, decreased pain, and decreased physical trauma to the body, minimally invasive surgery will significantly decrease the time required to remain in the hospital. Indeed, even for major procedures, patients will commonly return home after a single day in the hospital.
- Return to full activity. This is a term which is defined as the time for the patient to return to all normal activities and behaviors after surgery. This translates into an expedited return to family, work, and daily responsibilities. When the time for return to full activity is quantified in comparative studies, minimally invasive approaches dramatically reduce the time needed to truly recover from surgery. Indeed, in the case of kidney surgery, the time to recover completely has been reduced to approximately half to a quarter of the time needed to recover from more invasive approaches.
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Who and what is the Minimally Invasive Urology Team at Columbia University?
The Columbia University Department of Urology has assembled a dedicated team of surgeons and researches in minimally invasive urologic surgery in an effort to cure all urologic disease using the least invasive approach possible.
We take the team concept very seriously. By coordinating the efforts of the minimally invasive team with dedicated cancer surgeons, the minimally invasive urology team has been able to manage the majority of urologic diseases in a minimally invasive manner. Disease processes that are managed with minimally invasive technique are listed below. By coordinating together, the minimally invasive urology team offers a truly comprehensive approach to urologic diseases and we are able to tailor individual minimally invasive surgical care to each patient’s individual specific needs. As such, every patient has the opportunity to understand and choose among all minimally invasive modalities and technologies that are in clinical existence today. The patient’s individual minimally invasive strategy is then realized by a world class surgeon with tremendous clinical experience with the technique.
Dr. Jaime Landman – Director of minimally invasive urology
Dr. Mantu Gupta – Director of Endourology
Dr. Ketan Badani – Director of Robotic Surgery
Dr. Aaron Katz - Associate Professor of Clinical Urology
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What diseases are managed by which minimally invasive surgical approaches?
 It is very important to discuss all invasive and minimally invasive treatment options with your Urologist. Every patient is different, and it is important to incorporate patient and disease factors to achieve the optimal outcome. The list below is designed to provide information regarding minimally invasive options.
Prostate cancer
Watchful waiting / Active surveillance
Prostate cryoablation
Laparoscopic radical prostatectomy
Robotic laparoscopic radical prostatectomy
Kidney (Renal) cancer
Watchful waiting / Active surveillance
Kidney cryoablation
Laparoscopic partial nephrectomy
Laparoscopic radical nephrectomy
Bladder cancer
Transurethral resection of bladder tumor
Laparoscopic radical cystectomy
Testis cancer
Laparoscopic retroperitoneal lymph node dissection
Kidney stones
Watchful waiting / Active surveillance
Shockwave lithotripsy
Ureteroscopy
Percutaneous nephrolithotomy
` Laparoscopic pyelolithotomy / ureterolithotomy
Ureteropelvic junction obstruction
Watchful waiting / Active surveillance
Endopyelotomy
Laparoscopic pyeloplasty
Endopyeloplasty
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What is the future of urologic minimally invasive surgery?
 The future of minimally invasive urology is research. As we are dedicated to the continued improvement of the minimally invasive surgical philosophy, we have assembled a dedicated team to improve the future of patient care.
What is the Columbia minimally invasive urology research team?
The Columbia minimally invasive urology team has as one of its primary goals to continue to optimize patient outcomes though active research studies. The heart of the research team is the minimally invasive urology laboratory which is an ongoing active endeavor to which we are very dedicated.
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Who is on the minimally invasive urology research team?
 The minimally invasive urology research team exists under the directorship of Dr. Jaime Landman. Dr. Landman has extensive experience with clinical and basic science research. As a result of Dr. Landman’s research, he was recently awarded the Arthur Smith award. This Arthur Smith award is granted to the Urologist who has demonstrated the most innovation in minimally invasive urology research.
Dr. Landman has trained a number of fellows who have proceeded to practice minimally invasive urology and some have even initiated their own minimally invasive urology programs.
The minimally invasive urology team consists of two clinical fellows; a research fellow (1st year) and a clinical fellow (2nd year), a research coordinator, and a series of international research and teaching fellows.
Research projects:
The minimally invasive urology research team coordinates a wide variety of projects in an effort to advance all aspects of minimally invasive surgery and urology. The scope of the team’s work includes minimally invasive surgical education for students, residents and physicians, evaluation of minimally invasive surgical technologies, evaluation of novel ablative technologies and techniques, improved understanding of urinary tract physiology, etc.
Columbia University minimally invasive urologic oncology fellowship
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 Why the flying pig symbol for the minimally invasive urology team?
A common expression, “when pigs fly,” connotes the improbability of an event. Just five years ago, what is common practice today in minimally invasive urology seemed, and indeed was, impossible. Thanks to collaboration with biotechnology companies and the significant laboratory efforts, our team and other minimally invasive urology research teams around the world have made the “impossible” simply routine. The flying pig simply tells everyone that with collaboration, dynamic innovation, and some very hard work the minimally invasive urology team will “make pigs fly” on a routine basis.
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