The evolution of robotic surgery in urology

In the last two decades, robotic surgery has transformed the field of urology, reshaping traditional approaches. In his latest online article, Mr Philip Charlesworth explores the nuances of robotic surgery in urology, dispelling the misconception of autonomous robots.

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

Robotic surgery, integral to medical practice for almost two decades, has advanced across surgical domains. My involvement began in 2008 with prostate cancer removal, evolving through U.S. training to UK implementation in 2013.

Over the decade, robotic surgery's capabilities expanded, allowing removal of sizable growths and enhancing reconstructive possibilities. This technique, rooted in keyhole surgery principles, uses small incisions, gas, and specialised instruments controlled by surgeons via a console, dispelling the misconception of autonomous robots.

A notable advantage lies in controlled gas expansion, minimising blood loss in vascular-rich areas like the pelvis. Beyond reduced blood loss, robotic surgery offers less tissue damage, reducing stress, postoperative pain, and enabling quicker recovery. Our team's randomised control trial published in JAMA in 2022 revealed fewer complications in robotic surgeries, highlighting enhanced safety and quicker recovery. With a decade's experience, I advocate for robotic surgery's adoption due to its proven positive impact on patient outcomes, supported by global literature.

What are the most common urological operations?

Robotic prostatectomy is the most common urological procedure, crucial for treating prostate cancer. Recent advancements include nerve-sparing and continent-sparing techniques, enhancing post-surgery recovery and continence. Although my focus is on pelvic surgeries, there's widespread use of robotic technology in other urological procedures, especially related to kidney cancer. Colleagues excel in selectively removing a part of the kidney, preserving excellent cancer outcomes without sacrificing the entire organ.

In bladder cancer, I've pioneered techniques globally for robotic bladder removal and reconstructive options, optimising outcomes in complex procedures. Our robotic skills extend to various operations traditionally performed through open surgery, including addressing bladder stones, benign prostate enlargement, and reconstructing ureters. Collaborating with gynaecology surgeons, we've ventured into intricate work for pelvic cancers and bladder augmentation. While these listed procedures become rarer with evolving techniques, the most common ones – prostate, partial kidney, and bladder removal for cancer – persist, showcasing the growing versatility of robotic surgery in urological and pelvic procedures.

Are there any ongoing research or advancements in this field that could further improve patient outcomes?

Recently, the most exciting realm of research in robotics has centred around bladder cancer, particularly the groundbreaking multi-centre randomised control trial known as IROC. Published in JAMA in 2022, this trial, led by the UK, demonstrated the safety benefits and reduced complications associated with fully robotic removal of the bladder—marking a global first in this achievement.

I played a key role as one of the principal investigators in this groundbreaking project. During the course of the trial, we also discovered spin-off aspects, such as monitoring the activity levels of patients through wearable devices to assess their recovery post-surgery.

Looking ahead, the next thrilling frontier in research involves exploring new technologies. This extends beyond robotics to consider how we can optimise various generations of robots and the associated equipment. This includes advancements in energy devices, stapling devices, and related techniques. Anticipating the arrival of the single-port robot in the UK in early 2024, I am eager to be among the pioneers in adopting and developing this new technology, making it the first of its kind in Europe.

Mr Philip Charlesworth is a respected urologist with over 20 years of experience. You can schedule an appointment with Mr Charlesworth on his Top Doctors profile.