Robotic Applications in Urologic Oncology
Domlur, Bengaluru Feb 9, 2017
While Robots were initially introduced, they were used mostly for Cardiac Surgical Applications. Today, the majority of Medical Robotic applications are in the field of Urology. The Robot allows relatively less experienced laparoscopists to perform minimally invasive surgery better results even after a short learning curve. From the time of the first Urological Robot called PROBOT in 1989, Robotic technology has evolved to the current DaVinci System. Urological applications experiences with the DaVinci System is today one of the largest with Robots, across all specialities.
Robotic Radical Prostatectomy is clearly emerging as the front runner in new technologies in Urology. With the availability of large volumes of Long term efficacy and safety results, Robotic Prostatectomy has clearly occupied an eminent place in the management of prostate cancer. The advantages of Robotic access to prostatectomy are: better vision, ease of manoeuvrability in the pelvis, superior suturing ability, less blood loss, better ability to preserve neuro-vascular bundles, improved urinary continence rates, significantly less pain and early post operative recovery.
The use of Robots for renal surgery is now well defined. Most renal procedures such as a nephrectomy are standardized laparoscopic procedures and require no reconstruction. However, radical nephrectomy, radical nephro-ureterectomy and reconstructive renal and ureteral surgery are difficult for naive laparoscopic surgeons and Robot assistance offers definite advantages. Robotic Pyeloplasty for uretero-pelvic junction obstruction (UPJO) has become a standardized procedure with success rates equivalent to open pyeloplasty and significantly better than the Laparoscopic Pyeloplasty. Minimal morbidity due to its less invasive nature and superior reconstructive ability allows Robotic technology to be ideally suited in these cases. Reports also show shorter operative and anastomotic times with the Robot when compared with pure laparoscopy.
Robotic Nephron Sparing Surgery (Partial Nephrectomy) has clearly emerged to be a significantly superior technique in comparison to laparoscopic access. Complex partial resections are technically easy and superior reconstructive ability has made the Robotic Access attractive even in comparison to Open procedures. When coupled with minimal access, less blood loss and significantly less post operative pain translates into early postoperative recovery of the patient. Robotic Partial Nephrectomy is expected to be the procedure of choice in such diseases.
Cystectomy. urinary diversion and construction of the neo-bladder after radical cystectomy require significant surgical skills and the Robot is very helpful for this step.With the possibility of neuro-vascular bundle preserving cystectomy with orthotopic neo-bladder in both men and women, Robotic Radical Cystectomy may well become the standard of care for this debilitating condition. Intracorporeal anastomotic techniques are now standardized, and offer significantly less morbidity, even in comparison to the open procedure.
Robotic Access facilitates minimally invasive solutions also for several other Bladder Surgeries including the Partial Cystectomy, Ureteric Re-implantation and Augmentation Cystoplasty.
The ease with which the Robotic Technology facilitates Urinary Bladder Surgeries similar to Robotic Radical Prostatectomy, will make the Robot application as the access of choice in these diseases.
With increasing computing power, miniaturization, and advances in telecommunication, the surgical Robots will become more versatile and affordable. Similarly, industry is working on the development of instrumentation for suction, retraction, and hemostasis with these Robots. There are plans to develop surgical Robots which are MR compatible, giving advantage of real time MR imaging to the surgeon while operating with the Robot.
Robot assistance is emerging as a significant adjunct to all forms of surgical access including open and laparoscopic access for application in Urologic Oncology. The advantages for this technology are its enhanced shorter learning curve, dexterity, precision and ergonomics. Early post operative recovery with minimal morbidity makes the Robot more preferred when available.
With more and more institutions gaining access to this technology, Minimally Invasive Surgery will become more safe and attractive in the days ahead.