Robotic urology surgery is surgery associated with diseases that affect the male or female urinary tract & the male reproductive tract. The organs that fall under this field are kidneys, ureters, urethra, adrenal glands, urinary bladder and the male reproductive system (penis, testes, vas deferens, epididymis, seminal vesicles, prostate)
Robotics in the field of urological surgery has been an exciting development. In urology, robots have been applied in 2 areas: Endourology and Laparoscopy.
The earliest application of robotic Uro-surgery was reported at the Imperial College, London in 1989. The surgery was a trans-urethral resection of the prostate & the prototype robot (PROBOT) followed a detailed surgical plan outlined by the surgeon. This surgery illustrated the controlled, repetitive & precise movements the robot made, thus reducing human error.
The following procedures can be done in urology via a robotic system:
- Radical prostatectomy
- Partial nephrectomy
- Radical nephrectomy
- Radical nephroureterectomy
- Reconstructive renal & ureteral surgeries- ureteric re-implantation etc.
- Pyeloplasty for uretero-pelvic junction obstruction (UPJO)
- Urinary diversion
- Retroperitoneal and inguinal lymph nodes dissection
- Kidney transplantation
As of now, there is only one mainstream robotic system available to hospitals – DaVinci Surgical System. It consists of the following 3 parts:
Surgeon’s console: It has a 3D display interface & surgeons handles. The surgeon moves the handles resulting in the movements being mimicked by the instrument tips in real time. There is a force feedback to the operating surgeon’s hands & the camera movements are controlled by either a foot paddle or voice-activated the system, depending on your surgical system. A control panel displays all the information & the CPU controls and counterchecks the ability & performance of the machine.
Robotic Arms: consist of 3 surgical manipulators & 1 camera arm. The manipulators are basically the surgeon’s arms, driving the instruments with the camera arm helping in moving the camera unit, to maintain a good field of vision. These are either placed on a cart or on the surgical table.
Auxiliary cart: consists of camera units, light sources, camera signal synchronizers
The advantages of robotic surgery are:
- Three D natural vision
- Better hand-eye coordination
- Enhanced depth perception
- Seven degrees of freedom movements
- Ergonomic design
- Reduced chances of surgeon fatigue.
The disadvantages of robotic surgery are the cost and loss of tactile/haptic sensation.
Robotic urological surgery is slowly becoming the gold standard for certain procedures. In the case of cancer of the prostate, a daVinci prostatectomy is the preferred plan of treatment. The benefits of robotic prostatectomy over open prostatectomy & laparoscopic prostatectomy are as follows:
- Faster return of sexual function (erectile function)
- Increased chance of return of urinary continence within 6 months of surgery
- Less loss of blood
- Lower risk of wound infections & complications
- Shorter hospital stay & recovery time
- Better nerve sparing rate
A similar advantage is seen in other robotic surgery like Kidney transplantation where wound infection and lymphocele are almost eliminated by the robot. Patients also get less pain, fewer narcotics requirements, better cosmoses and early recovery. Radical prostatectomy and partial nephrectomy are the most commonly performed operations all across the world.
As of the 5000 robotic surgical systems presently used in the world, 500 of them are in Asia and 50 of them installed in India.