Robotics in Urology – The New Frontier

Dr Samit Chaturvedi

Urology has always been recognised as a super-specialty that embraces technologic advances. From the earliest cystoscopes and resectoscopes to flexible ureteroscopes and laparoscopy, urologists have always been at the forefront in adopting and applying surgical technology. Hence, use of surgical robots to date has been dominated by urologists. Following the success of robot-assisted laparoscopic prostatectomy in the 1990s, robotic surgery has expanded into other domains of urological procedures worldwide.

Robotic surgery is typically minimally invasive. So the patient suffers less pain, less infection, slight blood loss and minimal scarring, and requires only a short recovery time. With the robotic arm eliminating the natural limits of human wrists, surgery can be performed with more delicate, precise and efficient movements. The 3D imaging and endo-wrist technology of robots ensure surgery is more accurate and provide significant operative advantages over laparoscopic surgery. It is particularly useful when the operative field is narrow and deep and fine dissection and micro-suturing are required as with the intrapelvic anastomoses of kidney transplantation. Robot has improved the possibilities of preservation of nerve bundles and erectile function in radical prostatectomy, reduce blood loss and reduces margin positivity leading to a better chance of oncological and functional outcome than with non-robotic surgery. In patients with renal tumors, robot definitely  provides the advantage of magnified vision with better tumor removal and ease of precise renorrhaphy to improve outcomes. In complex cases like retro-peritoneal lymph node dissection (RPLND), renal tumors with IVC thrombus, ilio-inguinal lymph node dissection etc. cane be better performed with the help of robot with minimal morbidity.

The surgeon also enjoys more strength, dexterity, flexibility, control and a better view of the operated area.  Robotic surgery makes the procedure more ergonomical for surgeons and surgical assistants. It allows the surgeon to get more comfortable, perform the procedure with increased concentration and focus, and can undertake complex procedures that are tougher or impossible with other techniques.

Apart from Da vinci robotic system, multiple other robotic platforms are being made available such as HUGO robotic system by Medtronics, Versius robotic system by CMR and S.S. Mantra robot etc. which are going improve the versatility of surgical robot and reduce cost by increasing competition.

We, at Max super-speciality hospital, Saket have been using surgical robots (Da vinci Xi and Versius) to extend the advantages of this precision surgery to our patients for a long time now. We perform robotic surgeries for oncology cases (urological cancer cases), reconstructive cases and kidney transplantation. Some common robotic assisted urological surgical procedures performed at our centre are: Robotic radical/simple prostatectomy with pelvic lymph node dissection, Robotic cystectomy with ileal conduit/neo-bladder, Robotic total/partial nephrectomy,  Robotic pyeloplasty, Robotic  nephroureterectomy, Robotic adrenalectomy, Robotic ureteric reimplantation/Boari flap, vesico-vaginal fistula etc. We are one of the very few centers in the country to start and successfully run the Robotic kidney transplantation program.

The major limitation of robotic surgery is the high cost. But with many competing robotic platforms being available and the insurance cover is increasing, robotic surgery is becoming more affordable.

Now Artificial Intelligence is coming into the surgery in a big way and combined together with robotics, it will open a whole a new chapter in surgical treatment of patients. Therefore the future of robotic surgery seems more exciting.

As Advanced Urology Institute, we believe that surgical outcomes are a direct manifestation of the experience and skill of the surgeon, and the whole surgical team. We perform hundreds of laparoscopic and robotic surgeries every year and have achieved great success rates in terms of efficacy, cure and improved quality of life for our patients.

The authour is a Director – Uro-Oncology, Max Super Speciality Hospital, Saket, New Delhi

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