Robotic Urologic Surgery

Urology has consistently been recognised as a super-speciality that embraces technological advances. From the earliest cystoscopes and resectoscopes to flexible ureteroscopes and laparoscopies, urologists have always been at the forefront of adopting and applying surgical technology.

Hence, the use of surgical robots to date has been dominated by urologists. Following the success of robot-assisted laparoscopic prostatectomy in the 1990s, robotic surgery has expanded into other domains of urological procedures worldwide.

The two rival systems, ZEUS and Da Vinci pushed the frontiers of minimally invasive surgery. The ZEUS and Da Vinci system unified when Computer Motion, Inc., and Intuitive Surgical, Inc., merged in 2003. As a result, Intuitive Surgical, Inc. became the sole proprietor. Since then, the Da Vinci system has dominated the world of robotic surgery for almost two decades.

Two types of robotic systems are currently available; indeed, they can be OFF-LINE (FIXED PATH SYSTEMS) if they perform precise movements based on pre-programmed imaging studies obtained before surgery or ON-LINE (MASTER-SLAVE SYSTEMS) in which the robot replicates the surgeon’s movements in time real within the operating range. The Da Vinci robotic system falls into this second category.

Robotic surgery is typically minimally invasive. So the patient suffers less pain, less infection, slight blood loss and minimal scarring, and requires only a short recovery time. With the robotic arm eliminating the natural limits of human wrists, surgery can be performed with more delicate, precise and efficient movements.

The 3D imaging and endowrist technology of robots ensure surgery is more accurate and provide significant operative advantages over laparoscopic surgery, particularly when the operative field is narrow and deep and fine dissection and micro-suturing are required as with the intrapelvic anastomoses of kidney transplantation or preservation of nerve bundles and erectile function in radical prostatectomy, and there is also a better chance of cure than with non-robotic surgery.

The surgeon also enjoys more strength, dexterity, flexibility, control and a better view of the operated area. Robotic surgery allows the surgeon to get more comfortable, perform the procedure with increased concentration and focus, and can undertake complex procedures that are tougher or impossible with other techniques.

Apart from the Da Vinci robotic system, multiple other robotic platforms are being made available such as the HUGO robotic system by Medtronic, the Versius robotic system by CMR and the Mantra robot etc., which are going to improve the versatility of surgical robots and reduce cost by increasing competition.

We at Max Super-Speciality Hospital have been using surgical robots (Da Vinci and Versius) to extend the advantages of this precision surgery to our patients for a long time now. Some of the common robotic-assisted urological surgical procedures performed at our centre are Robotic radical/simple prostatectomy with pelvic lymph node dissection, Robotic cystectomy with ileal conduit/neo-bladder, Robotic total/partial nephrectomy, Robotic pyeloplasty, Robotic nephroureterectomy, Robotic adrenalectomy, Robotic ureteric reimplantation/Boari flap, vesico-vaginal fistula etc. We are one of the few centres in the country to start and successfully run the Robotic kidney transplantation program.

The major limitation of robotic surgery is the high cost. But with many competing robotic platforms being available and insurance coverage increasing, robotic surgery will be more affordable in future.

Now Artificial Intelligence is coming into surgery in a big way and combined together with robotics, it will open a whole new chapter in the surgical treatment of patients. Therefore the future of robotic surgery seems more exciting.

As an advanced urology institute, we believe that surgical outcomes are a direct manifestation of the experience and skill of the surgeon and the whole surgical team. We perform hundreds of laparoscopic and robotic surgeries every year and have achieved great success rates in terms of efficacy, cure and improved quality of life for our patients.