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The Role of Robotics in Urological Surgeries | Max Hospital

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How Robotics is Shaping Modern Urological Surgical Practices - Challenges & Evolution

By Dr. Amit Goel in Urology , Uro-Oncology

May 27 , 2024 | 3 min read

Robotics in surgery refers to the use of robotic systems to assist in performing surgical procedures. This technology has advanced significantly in recent years, providing surgeons with enhanced precision, control, and access during various surgical interventions.

False Notion Unveiled

What comes to your mind when you hear of a robot assisting in a surgery? A machine pre-programmed to perform complex surgeries on its own, with minimal surgeon intervention? Well, the fact is that the robot does not operate or perform surgeries on its own. Surgeons themselves perform the surgery- the movements performed on the console are controlled and replicated by thin robotic instruments inside the patient's body. Hence, it is not a replacement for the surgeon but an assistance, thereby saving time and achieving more efficiency.

The Journey

The evolution of robotic surgery has been a fascinating journey, marked by technological advancements, increasing safety and adaptability, and expanding applications. Here's a brief overview of key milestones in the evolution of robotic surgery:

The concept of using robots in surgery began to fall into place in the 1980s. Unimation, a company in New Jersey, USA, developed PUMA 560, an industrial robotic arm used in the first documented robotic surgery in 1985 for a neurosurgical biopsy. Intuitive Surgical in California introduced the Da Vinci Surgical System in 2000, marking a significant milestone. 

Since then, robots have been extensively developed and used in almost all medical branches like urology, gynecology, intestinal surgeries, thoracic surgeries and many more. Robots currently in use: Intuitive Da Vinci Surgical System, Medtronics, Hugo RAS and many other systems are in the evolution phase.

Urology and Robotics

Why is robotic assistance a boon for urological surgeons? It lets the uro-surgeon reach far away interior parts of the body. Robotic systems provide unmatched precision and dexterity, enabling surgeons to perform intricate tasks with accuracy using smaller incisions with the help of articulating instruments called Endowrist. High-definition 3D imaging gives surgeons a magnified and detailed view of the surgical site, i.e., an inside view of the patient's body. The surgeon has a better capability of operating in limited spaces along with smaller incisions.

Robotic surgeries are minimally invasive, reduce pain, bleeding and other complications for the patient, minimize scarring and shorten hospital stays and recovery times when compared to conventional surgeries.

Commonly performed robot-assisted urological procedures include:

  • Radical Prostatectomy for prostate cancer
  • Radical cystectomy (removal of bladder and neobladder formation for bladder cancer)
  • Partial nephrectomy (a part of the kidney with a tumor is removed in kidney cancer)
  • Retroperitoneal Lymph Node Dissection for testicular tumors
  • Nephroureterectomy for ureter cancer
  • Adrenal Tumor Excision
  • Inguinal Lymph Node dissection for penile cancer
  • Pyeloplasty for Pelviureteric Junction Obstruction
  • Ureteric Reimplantation
  • Bladder Augmentation
  • Kidney Transplantation

Other surgeries assisted by robots include colorectal surgery, intestinal surgery, pancreatic cancer surgery, oesophageal cancer surgery, heart surgery, and transthoracic surgery (like VATS- video-assisted thoracoscopic surgery) for lung tumors, hernia repair, and cholecystectomy. Radical hysterectomy for uterine cancer and myomectomy can also benefit from robotic assistance.

Challenges in Robotic Surgery

Robotic surgical systems are expensive to acquire and maintain, limiting their availability in some healthcare settings. Also, the learning curve of robotics is steep and operating surgeons need specialized mentored training and experience to operate robotic systems effectively. This is in sync with the Hippocratic Oath, which says do no harm.

Eventuality of Robotic Surgery

The evolution of robotic surgery is eminent and promises an energetic field with ongoing technological development, keeping in focus the commitment to improving patient outcomes, reducing invasiveness, and expanding the range of surgical procedures that can benefit from robotic assistance. As technology continues to evolve year after year with the addition of nuances, robotic surgery holds the promise of further innovation and broader accessibility.

In future, robots may be used with Artificial Intelligence (AI). AI algorithms enhance automation and can assist in making judgements, which might help in pre-operative planning, intraoperative guidance, and postoperative analysis. Further advancements may enable surgeons to perform procedures remotely, broadening access to surgical proficiency.

Overall, robotics in surgery continues to progress, offering promising advancements in terms of patient outcomes, surgical capabilities, and the range of applicable procedures.