Robotic Surgery In Urology
Robotic surgery, a minimally invasive procedure, is gaining popularity in surgery, especially in urology. Major urological procedures like partial nephrectomy and radical prostatectomy are increasingly being performed using laparoscopic and robotic minimally invasive techniques. The practice of robotic surgery is constantly developing to increase its effectiveness and minimally invasiveness.
As technology makes complex surgeries easier to conduct than through open surgery, robotic surgery is regarded as safe. Every surgery has some dangers, but there is less bleeding and less discomfort in robotic surgery. Robot-assisted surgery requires very skilled and experienced surgeons.
Not all patients are candidates for robotic surgery, and not all surgeries are carried out by robots. Patients discuss the advantages and disadvantages of robotic surgery and alternative procedures with the doctor or other healthcare provider. Additionally, not every hospital and healthcare facility offers robotic surgery. It may only be provided in highly specialized or private hospitals, depending on the nation. (1,2)
Definition and Overview
Urological robotic surgery is a modern surgical technique that uses robotic types of equipment to help urologists in performing many urological procedures. It enhances surgical outcomes and patient care by fusing the accuracy of robotic technology with surgical skills. The field has undergone notable advancements recently and is now a crucial component of contemporary urological practice.
In comparison to open surgery, the use of robotic assistance in these procedures has been linked to several benefits, including less blood loss, a shorter hospital stay, reduced post-operative pain, improved cosmetic results, and quicker recovery times. Because technology makes complex surgeries easier to perform than open surgery, robotic surgery is regarded as safe.
Robotic surgery can treat a number of urological diseases and conditions including prostate cancer, kidney cancer, kidney obstruction, kidney, ureter, and bladder reconstruction, and prostate removal for BPH. (3)
- Prostatectomy (removal of the prostate)
In a prostatectomy, the prostate is surgically removed by a urologist to treat benign prostatic hyperplasia or prostate cancer. A simple prostatectomy and a radical prostatectomy are the two primary forms. Incontinence, erectile dysfunction, and surgical complications are among the risks involved. After four to ten weeks, most people are back to normal.
- Partial and radical Nephrectomy (removal of part or all of the kidney)
Surgery to remove a kidney is called a nephrectomy. To merely remove a section of the kidney, the surgeon may conduct a partial nephrectomy. Alternatively, the patient can undergo a radical nephrectomy in which the doctor removes the whole kidney. Nephrectomy can save a patient's life if they have cancer or kidney illness.
- Pyelo/Ureteroplasty (removal and reconstruction of part of the urinary tract)
A procedure called a pyeloplasty/ureteroplasty fixes the tube connecting the kidneys and bladder. This hospital operation, done by a general surgeon or urologist, resolves ureteropelvic junction (UPJ) obstruction. It might necessitate a two-day hospital stay on average.
- Cystectomy (removal of parts or all of the bladder)
The removal of the bladder entirely or partially is known as a cystectomy. Most surgeons recommend employing it to treat bladder cancer. If the entire bladder is removed, a new route is opened for the body to release urine. Bleeding, infection, and negative sexual consequences are risks. It may take a few weeks to several months to recover.
- Retroperitoneal Lymph Node Dissection or RPLND (removal of the lymph nodes at the back of the abdomen)
RPLND is an extended procedure that is frequently carried out under general anesthesia and is utilized to stage cancer as well as prevent it from spreading throughout the body. The abdomen's lymph nodes are removed by the surgeon during the procedure. (4)
Robotic surgery is not suitable for every patient and not all surgeries are performed using robots. Robotic surgery is generally suitable for patients who have
- prostate cancer,
- kidney tumors,
- bladder cancer,
- urinary tract reconstruction,
- and other urological conditions, such as adrenal gland tumors, retroperitoneal tumors, and urethral strictures, (5)
Risks and Side Effects
Since technology makes complex surgeries easier to conduct than open surgery, robotic surgery is usually regarded as safe. It does, however, have a few risks and side effects that can differ from person to person, just like any medical procedure. These include
- Infection at the surgical site
- Adjacent tissue/organ damage
- Urinary incontinence (inability to control urine)
- Erectile dysfunction (impotence)
- Urine leakage
- Genitourinary (6,7,8)
Post-Procedure and Follow-up
Following robotic surgery in urology, the post-procedure phase is crucial for ensuring appropriate recovery, controlling potential problems, and fostering the best possible results.
The doctor schedules medical follow-up appointments to ensure a full recovery and successful results. The patient's wounds and stitches are examined at these appointments. For instance, the doctor would perform tests to ensure that the kidney cancer is completely gone if the kidney cancer was removed.
The doctor can remove the patient's stitches after 1-2 weeks if they do not dissolve. They also take out any drainage tubes the patient might have. To check on their urological health, most patients receive CT scans or other imaging tests one month, 12 months, and 24 months after their surgery.
Depending on the urological procedure the patient undergoes, recovery may vary. For instance, patients who undergo partial cystectomies typically recover more quickly than those who undergo radical cystectomies.
Following a urologic robotic surgery, many patients experience anorexia and irregular bowel function (constipation, loose stools, or both), and a full recovery could take several weeks to months. This is a direct effect of the body diverting urine through a portion of the colon.
Patients must carefully adhere to the post-procedure instructions given by the surgical teams, keep to medication regimens, show up for planned appointments, and report any related symptoms or complications as soon as possible.
In urology, robotic surgery seeks to offer a minimally invasive method with better patient outcomes, precision, and control. By providing patients with safer, more effective, and more efficient urological surgical procedures, it serves as a platform for the advancement of surgical techniques and education.
1,3,4- European Association of Urology. Robotic surgery in urology. (https://patients.uroweb.org/treatments/robotic-surgery-in-urology/#:~:text=the%20general%20anesthesia.-,What%20types%20of%20robotic%20surgery%20are%20there%3F,Prostatectomy%20(removal%20of%20the%20prostate))
2- AME Medical Journal. Robotic surgery in urology: a review from the beginning to the single-site (https://amj.amegroups.com/article/view/6515/html)
5- National Institute of Diabetes and Digestive and Kidney Disease. Urologic Diseases (https://www.niddk.nih.gov/health-information/urologic-diseases)
6- American Urological Association Journals. Complications After Robotic Partial Nephrectomy at Centers of Excellence: Multi-Institutional Analysis of 450 Cases. (https://www.auajournals.org/doi/full/10.1016/j.juro.2011.03.127)
7- Johns Hopkins Medicine. Robotic Prostatectomy. (https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/robotic-prostatectomy)
8- National Library of Medicine. Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. (https://pubmed.ncbi.nlm.nih.gov/23380164/)