Robotic Surgery & Urology
Anastasios D. Kalantzis, Surgeon Urologist-Andrologist
Robotic surgery is a technique in which a surgeon performs surgery using a computer that remotely controls very small instruments attached to robotic arms, allowing the surgeon to perform the small, precise movements that are possible with this type of surgery. A thin tube with a camera, called endoscope, attached to the end of it, allows the surgeon to view, in real time, highly magnified three-dimensional images of the body on a monitor. On the other hand, laparoscopy, or laparoscopic-assisted surgery, refers to a group of operations performed with the aid of a camera placed in the abdomen or pelvis and allows doctors to perform both minor and complex surgeries with a few small cuts in the abdomen, as well as diagnose conditions (diagnostic laparoscopy).
Urology is the medical specialty that uses robotic or laparoscopic-assisted surgery more than any other specialty. However, the necessary studies that compare the results of older surgical techniques and the new surgical methods have not been conducted yet.
New surgeons consider robotic surgery to be more attractive. This is not due to the fact that the older techniques do not have the same or better results; simply, the developments in technology and the minimally invasive techniques will dispense with the old, classic techniques, considering them obsolete.
The advantages of robotic surgery are:
- Less tissue trauma.
- Smaller incisions (a few millimeters).
- Decreased blood loss.
- Less post-operative pain.
- Reduced duration of hospital stay.
- Quicker healing time and faster return of the patient to their daily activities.
- Less post-operative complications associated with the trauma (suppuration, dehiscence, post-operative incisional herniaetc.)
The disadvantages of robotic surgery are not many. Apart from the fact that the surgeon should receive special and specific training in order to conduct robotic surgery, the major disadvantage of an operation of this type is its high cost.
The applications of robotic surgery in urology are the following:
- Robotic simple nephrectomy to anon-functional wrinkled or hydronephrotic kidney.
- Robotic radical nephrectomy, in cases of renal cancer
- Robotic partial nephrectomy, in cases of renal tumors of size up to 4cm.
- Robotic removal of symptomatic or large renal cysts.
- Robotic nephropexy in cases of symptomatic nephroptosis
- Robotic pyeloplasty in cases of ureteropelvic junction obstruction.
- Robotic pyelolithotomy / ureterolithotomy for calculi that can not be treated endoscopically.
- Robotic nephroureterectomy, in case oftumorsin thetransitional epithelium of the renal pelvis and the ureter.
- Robotic ureterectomy and ureter reimplantin case of injuries or malignant conditions of the distal (lower) part of the ureter.
- Robotic removal of ureteral strictures and nissen fundoplication Adrenal gland surgery
- Robotic adrenal gland ectomy, in adrenal gland masses
Urinary Bladder surgery
- Robotic diverticulectomy in bladder diverticula
- Robotic lymphadenectomy in malignant conditions of the urinary tract system.
- Roboticprostatectomy, inorganconfinedprostaticcancer.
- Robotic ligature of the internal spermatic veins in cases of varicocele.
- Robotic-assisted retroperitoneal lymph node dissection (RPLND)in cases of testicular cancer
What we should realize and know is that no machine, technological equipment or robot can replace the surgeon. According to my experience as a surgeon, the method that will be followed for the treatment of a condition does not depend on the condition itself. Otherfactors, suchasthepatient’smedicalhistoryandage, theextent of the problem etc., are those that will give the doctor a complete view of the situation, so that he/she can decide on the most appropriate operative technique that must be followed in order to properly address and cope with the problem.