Over the last decade, using robot-assisted surgery to treat urological conditions has accelerated.
Before, most procedures for urology were open surgeries. Compared to open procedures, which use large incisions, robotic surgeries are minimally invasive. They create smaller incisions, leading to less pain and a shorter recovery time.
“Robotic surgery accomplishes the same as open-approach surgery, without intensive training in laparoscopy,” says Michael Ost, MD, director, Pediatric Surgical Outreach, UPMC Children’s Hospital of Pittsburgh, and assistant dean, Interprofessional Education and Technology, University of Pittsburgh School of Medicine.
Dr. Ost treats both adult and pediatric patients for urological conditions.
What Are Urological Conditions and Diseases?
Urological conditions affect the male reproductive organs or problems with the male or female urinary tract. This can include problems in the:
- Kidney and ureter
Surgery may be the only option to cure or relieve the symptoms of some urological conditions. This includes certain cancers, kidney disorders, urinary tract obstructions, and reconstructive procedures.
What Is Robotic Surgery?
In robotic surgery, or robot-assisted surgery, a surgeon performs the procedure through smaller eight to 12 millimeter incisions while at a console, using a robotic surgical platform. Robotic surgery can treat urological conditions in both children and adults.
The most common system used in robotic procedures is the da Vinci® Surgical System. The system can assist with both common and complex procedures.
In addition to their normal surgical training, surgeons receive training in how to use the robotic system.
“It gives a well-trained surgeon the opportunity to perform minimally invasive surgery quicker than if the technology had not existed,” Dr. Ost says. “It accelerates that skill set.”
What Happens During Robotic Urological Surgery?
After the surgical team places someone under anesthesia, the surgeon makes small incisions in the abdomen. There, the team inserts three or four small port sites, where they place tiny surgical instruments and a small, three-dimensional camera.
The surgeon sits at a console with a 3-D screen and operates the surgical instruments.
“(The console) allows those instruments to be maneuvered and steered with both hand motion and foot control,” Dr. Ost says. “And that translates into 7 degrees of freedom of robotic arm movement so that you’re minimally limited in how you operate.”
The surgeon is in control of the operation at all times. The robotic system helps perform sensitive operations like prostatectomy, where the surgeon has to work in a very small space while protecting the surrounding nerves.
What Are the Benefits of Robotic Surgery?
Advantages of robotic surgery for urological conditions include:
- Smaller incisions and less scarring.
- More precision and control by the surgeon.
- Less blood loss.
- Shorter hospital stays.
- Faster recovery.
“The advantages of doing a robotic case are, first and foremost, their recovery,” Dr. Ost says. “The time that they will stay in the hospital and return to normal activity will be quicker than an open incision.
Robotic surgery can also allow for more complex reconstructive surgeries.
“The robot has an advantage that we’re able to reach far down into the pelvis with superior visibility, and actually, it can be more advantageous than an open incision,” Dr. Ost says.
The cosmetic advantage of robotic surgery may be especially important for treating children.
“Due to smaller incisions, there is less scarring, which is much more of a concern for children and parents,” Dr. Ost says. “Incisions in childhood do grow with them over time. So, a significant-sized incision in a child will be a very big incision in an adult. But a small incision in a child will remain small.”
Types of Robotic Urological Surgery
Robotic surgery is offered as an option for almost every major urological surgery done at UPMC. Some patients with larger tumors or previous surgery may not be good candidates.
According to Dr. Ost, the majority of adult surgeries in the field of urology are robot-assisted. For some cancers, like prostate cancer, the number is 80% or higher. In children, most reconstructive procedures for the kidney or ureter are robot-assisted.
In a prostatectomy, a surgeon removes all or part of the prostate.
A radical prostatectomy is a common surgery to treat prostate cancer. The surgery uses small incisions in the belly to remove the prostate gland and surrounding tissue. The surgeon carefully reattaches the bladder to the urethra, sparing the nerves for erections.
A simple prostatectomy is used when the prostate is not cancerous but instead is very enlarged. The surgeon can remove the inner or blocking part of the prostate, opening the channel for urination.
Compared to a full nephrectomy, which removes your kidney, a partial nephrectomy removes only part of the kidney. It’s a common procedure to treat kidney cancer.
Also called kidney-sparing surgery, a partial nephrectomy removes the diseased part of the kidney only while leaving the rest of the kidney intact. This leaves the patient with better kidney function and less chance of needing dialysis than if the whole organ is removed.
This procedure for bladder cancer can be done as a partial or radical cystectomy. A partial cystectomy removes only the cancerous part of the bladder. More commonly, a radical cystectomy removes the bladder, nearby lymph nodes, part of the urethra, and any other nearby organs where cancer has spread.
Pyeloplasty (urinary reconstruction surgery)
This procedure removes a urinary blockage between the kidney and the ureter tube, which drains toward the bladder. The surgeon removes the blockage and then re-attaches the kidney to the healthy part of the ureter.
The ureters are the muscular tubes connecting your kidneys and bladder. Several different types of robotic surgery can repair damage stemming from a blockage or an injury.
Ureteral reimplantation can help treat reflux, which occurs when urine travels backward from the bladder to the kidneys. The surgeon makes a small incision in the abdomen and repositions — or reimplants — the ureter into a different position on the bladder.
If too much of a ureter is removed to allow for normal reimplantation, surgeons can perform reimplantation with a psoas hitch (pulling the bladder up and sewing it to the psoas muscle, which runs from the pelvis to femur), or a Boari flap (creating a flap from the bladder to reach the ureter).
A ureteroureterostomy (UU) removes a small diseased portion of the ureter and reconnects the remaining portions of the tube to fix a blockage.
Robotic Surgery Risks
Robotic surgery has risks similar to any other surgery. All surgery carries the risk of infection, bleeding, and other complications. With robotic surgery, there’s a chance the surgeon may need to change to an open procedure, but this is uncommon. There also is a risk of technical malfunction, but it is very rare.
UPMC surgical teams are well-trained and prepared to handle any possible complications. Talk to your doctor about whether this type of surgery may be the best option for you.
For more information on robot-assisted surgery, visit the UPMC Robotic Surgery website.
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