Robotic surgery in urology: an expert's guide

Robotic surgery is a new technique that greatly improves the outcome of surgical procedures. In his latest online article, consultant urologist and robotic prostate and bladder cancer surgeon Mr Ashwin Sridhar explains everything you need to know about robotic surgery in urology.

What is robotic surgery in urology, and how does it differ from traditional surgical approaches?

Robotic surgery in urology is a minimally invasive surgical technique that uses a robotic system to perform urological procedures. The robotic system consists of a surgeon console, a patient-side cart, and a vision system. The surgeon sits at the console and controls the robotic arms, which are inserted into the patient through small incisions. The vision system provides the surgeon with a three-dimensional view of the surgical field, which is magnified up to 10 times.

Here are some of the most common urological procedures that are performed using robotic surgery:

• Radical prostatectomy: This is a surgery to remove the prostate gland. It is used to treat prostate cancer.
• Partial nephrectomy: This is a surgery to remove part of a kidney. It is used to treat kidney cancer.
• Nephroureterectomy: This is a surgery to remove a kidney and a ureter. It is used to treat kidney cancer that has spread to the ureter.
• Cystectomy: This is a surgery to remove the bladder. It is used to treat bladder cancer.
• Pyeloplasty: This is a surgery to repair a narrowing of the ureter.
• Robotic surgery is a rapidly evolving field, and new urological procedures are being developed all the time.

What are the advantages and benefits of robotic surgery in urological procedures?

Robotic surgery offers several advantages over traditional surgical approaches, including:

• Smaller incisions: Robotic surgery uses small incisions, which can lead to less pain, faster recovery, and a reduced risk of infection.
• Improved precision: The robotic arms are very precise, which allows the surgeon to make small, delicate movements. This can be helpful in procedures that require a high degree of precision, such as prostatectomy.
• Enhanced visualization: The three-dimensional view of the surgical field provided by the vision system allows the surgeon to see more clearly than with traditional laparoscopy. This can help the surgeon identify and avoid critical structures.

How is robotic surgery performed in urology, and what are the key components of the robotic surgical system?

Many robotic systems are available that allow us to do robotic surgery. The most widely used system is the Intuitive Surgical da Vinci system. The robotic system consists of a surgeon console, a patient-side cart, and a vision system. The surgeon sits at the console and controls the robotic arms, which are inserted into the patient through small incisions. The vision system provides the surgeon with a three-dimensional view of the surgical field, which is magnified up to 10 times.

Robotic surgery is performed in the following steps:

• The patient is placed under general anaesthesia.
• The surgeon makes small incisions in the abdomen.
• The robotic arms are inserted into the incisions.
• The surgeon uses robotic arms to perform the surgery.
• The robotic arms are removed from the incisions.
• The incisions are closed.

The key components of the robotic surgical system are:

Surgeon console: The surgeon console is where the surgeon sits and controls the robotic arms. The console has a three-dimensional view of the surgical field, which is magnified up to 10 times. The surgeon uses the console to move the robotic arms and to perform the surgery.

Patient-side cart: The patient-side cart contains the robotic arms. The robotic arms are connected to the patient-side cart by cables. The patient-side cart also contains the vision system.

Vision system: The vision system provides the surgeon with a three-dimensional view of the surgical field. The vision system is located in the patient-side cart.

Which urological conditions or procedures can be effectively treated using robotic surgery, and are there any limitations or contraindications?

Some of the most common urological procedures that are performed using robotic surgery include:

• Radical prostatectomy: This is a surgery to remove the prostate gland. It is used to treat prostate cancer.
• Partial nephrectomy: This is a surgery to remove part of a kidney. It is used to treat kidney cancer.
• Nephroureterectomy: This is a surgery to remove a kidney and a ureter. It is used to treat kidney cancer that has spread to the ureter.
• Cystectomy: This is a surgery to remove the bladder. It is used to treat bladder cancer. We can create a new bladder after this if needed as part of the same surgery.
• Pyeloplasty: This is a surgery to repair a narrowing of the ureter.

Robotic surgery is a rapidly evolving field, and new urological procedures are being developed all the time. As the technology continues to improve, robotic surgery is likely to become even more common in the treatment of other urological conditions.

What is the recovery process like for patients undergoing robotic surgery, and what are the potential complications or risks associated with this advanced technique?

Robotic surgery is not without its risks. These risks include:

• Cost: Robotic surgery could be more expensive than traditional surgical approaches. However, when performed by an experienced team, the benefits of reduced hospital stay, reduced risk of complications and reduced risk of readmissions could level this cost.
• Learning curve: It takes time for surgeons to learn how to use the robotic system. Therefore, it is essential you choose a high-volume surgeon/surgical team.
• Technical challenges: Robotic surgery can be technically challenging. These are common to all minimally invasive approaches like laparoscopic surgery as well.
• The position you are in during surgery could have effects on your eyes/brain/muscles. Normally these are minimal and the team will assess these risks prior to surgery.
• The gas insufflation needed for surgery is absorbed by the body over time. In most patients this is inconsequential. In some patients, this absorbed gas could affect breathing and blood circulation. Again, the risk for this can be assessed, monitored and treated. 
• If a space can’t be created to do the operation, then you might need a conventional surgical approach.
• Device failure. This is very rare and with experienced teams, this can be managed very easily.

Overall, robotic surgery is a safe and effective minimally invasive surgical technique that can offer several advantages over traditional surgical approaches. However, it is important to weigh the risks and benefits of robotic surgery before making a decision.

Mr Ashwin Sridhar is a renowned consultant urologist and robotic prostate and bladder cancer surgeon in London. If you would like to book a consultation with Mr Sridhar, you can do so today via his Top Doctors profile.