Minimal and direct access surgery in urology.

An alternative method to laparoscopic surgery has been developed for urological procedures. The surgery is minimal access because the length of the single skin incision ranges from 3-6 cm depending on the type of operation. It is direct access because the surgeon sees the operative area directly and stereoscopically by eye without video-optical support. The procedure requires a special open-lumen retractorscope (Jakoscope(TM)) with a high intensity fiberoptic light system and modified standard hand instruments. Among the procedures performed nephrectomy, ureterolithotomy, prostatic adenomectomy, spermatic vein ligation and others have been performed. The kidney procedures have been operated retroperitoneally through a minilumbotomy incision. The procedures are simple, rapid and the instruments are inexpensive. The postoperative pain and morbidity are comparable to the laparoscopic approach.