Robot-assisted surgery in urology

With advancements in technology, surgery for urological conditions has been revolutionised over the past 30 years. Mr Aniruddha Chakravarti, a leading consultant urological surgeon, spoke with us about robot-assisted surgery and the positive impact it has had on urology. We also discussed how it compares with older techniques.
 

We wanted to find out to what extent robotics and artificial intelligence (AI) will be able to be used in future and whether they will ever be able to match the expertise, precision and care that our surgeons such as Mr Chakravarti offer.

How does robot-assisted surgery compare to traditional surgery?

Urological surgery used to be performed with an ‘open surgery’ approach in the past and then in 1990, laparoscopic surgery came and we started performing minimally invasive laparoscopic surgery. Immediately, it was noticed that there is a huge difference.
 

Minimally invasive surgery offers many advantages. It improves vision for surgeons performing procedures, it is less painful for patients, and there is less blood loss. Minimally invasive surgery made surgery much better and did not compromise results.
 

When we adopted laparoscopic (minimally invasive) surgery at my clinic, we were well aware that it had limitations in terms of ergonomics and vision because it reflected a two-dimensional picture instead of 3 dimensional and there was no tactile sensation.
 

Since then, there has been a continuous speed of improvement in technology. When robotic surgery finally arrived, it enabled a much high degree of 3-dimensional vision. The instruments are extremely human-like or even better, there is much more precision when operating.
 

Urological surgeons, including myself, are one step further in terms of patient safety, improved quality of care, and getting the desired outcomes in approach to surgery. Robot-assisted surgery is still under development, although urologists worldwide have adopted it as much as they can.
 

So, what are the main advantages of robotic surgery over traditional surgery?

•  Improved vision, very detailed and three dimensional.
•  Better precision in terms of wristed movement of instruments.
•  Better control of blood loss tissue planes and everything.
•  Enhanced recovery.
   

Traditional surgery impacts the inside of the organs inside the abdomen and this affects the recovery of the patients, this is why robotic surgery is preferable.
 

How much does robotic surgery cost in urology?

This is the main hindrance behind the wider adoption of the technology. Although it’s been in place for more than ten years, roughly fifteen, the adoption in general is not that great because of prohibitive costs. The current robots are from Intuitive Surgical, Inc. The capital costs approximately two million pounds plus a huge maintenance cost for the instruments.
 

So, unless you have a significant caseload, you cannot afford this kind of equipment. Therefore, they’re mostly only available in large tertiary medical centres.
 

Is robotic surgery more dangerous?

It’s not, as long as the surgeon is appropriately trained, there are well-defined pathways that are well structured. If the surgery follows it and if trained, it should be safer.
 

Will robots ever replace surgeons?

The baseline answer is, not in the near future but it’s in continuous development. A lot of development is going on at the moment that is focusing on trying to infuse AI for surgery. With continuous improvements in artificial intelligence and machine learning, we hope there will be a day when we will get more out of the robots.
 

However, in my opinion I do not think a robot will be able to completely replace surgeons due to how human anatomy in patients changes from time to time. Whether a programmed robot will be able to replace humans who perform urological surgery remains to be seen but this is a question that needs to be answered in the future.
 

For more information regarding robotic surgery, we recommend getting in contact with Mr Chakravarti, a highly experienced consultant urological surgeon based in London.