Robotic Surgery has been on the rise lately as a revolutionary tool in the field of medicine and surgeries. Its use has become the norm in many countries around the world. The term “Robotic Surgery” mainly refers to the case where surgeries are performed with the assistance of robotic systems allowing surgeons to perform complex operations through very miniature incisions and resulting in better outcome and enhanced patient recovery.
Robotic-Assisted Urologic Procedures
Many urologic procedures are performed through the robot but the 3 most essential urologic surgeries through robot are:
– Partial and Total Nephrectomy (kidney surgery)
– Prostatectomy (prostate surgery)
– Cystectomy (bladder surgery)
Surgeries Through Robot
Kidney Surgery (in case of kidney cancer)
When kidney cancer is diagnosed, your doctor may recommend a partial nephrectomy (the surgeon removes also the tumor, in order to preserve as much healthy kidney tissue as possible); or a radical nephrectomy (the surgeon removes all the affected kidney).
Surgeons can perform kidney surgery through open surgery or minimally invasive surgery.
Traditional open surgery is performed through a long incision in your side, abdomen, or back; and during this procedure, the surgeon looks directly at the surgical area and removes part or all of the kidney using hand-held tools.
The best minimally invasive procedure to perform a kidney surgery (radical or partial nephrectomy) is robotic-assisted surgery, possibly with da Vinci technology.
Surgeons using the da Vinci system may be able to perform kidney surgery through a few small incisions (cuts) and a 3D high-definition vision system using tiny instruments.
When the nephrectomy through the robot is done, the patient:
– Will not present any complications.
-Will stay in the hospital for one or two days maximum.
-Will not lose a lot of blood.
-May experience less pain.
-Through the robot, we can complete lymph node dissections that may match or surpass what most experienced open surgeons are able to offer.
In case of a prostate cancer, the robotic surgery has an essential role in tumor resection; without causing incontinence and erectile dysfunction.
A radical prostatectomy can be performed through open surgery, which requires a large incision in your abdomen, or a minimally invasive technique.
With the da Vinci system, the surgeon can achieve the procedure with more precision through small incisions; while the cancerous prostate gland is resected with clarity, the erectile function is not affected most of the time and the patient experiences a faster return of urinary continence.
Through the robot, the patient may stay in the hospital for a shorter amount of time and the urinary catheter is no longer kept for several days.
A cystectomy is a major surgery to remove all the bladder (radical cystectomy) or part of the bladder (partial cystectomy), and this procedure helps to treat bladder cancer.
When the disease is in an advanced stage, the bladder should be removed completely. Through the traditional surgeries, people needed to have an external pouch to collect their urine; but now with the robot which gives more precision, surgeons have developed ways to construct a bladder substitute: a neobladder (your urologist uses a long piece of the small intestine to create a continent reservoir to store urine).
Bladder cancer presents a special challenge for robotic surgery which has multiple advantages for patients:
– A better view of the tissue through the 3D high-definition view.
-Less blood loss than open surgery.
-Low risk of complications and infections.
-Shorter recovery period especially for a partial cystectomy.
Robotic partial nephrectomy surgery consists of removing a part of a kidney, to treat cancer by preserving as much healthy kidney tissue as possible.
Who needs a robotic partial nephrectomy?
-Patient with small kidney tumor (<4 cm in size).
-Patient with risk of kidney failure and the need of dialysis when the procedure consists of removing all the kidney.
Kidney Tumors between 4 and 7 centimeters can be treated with robotic partial nephrectomy if they are located in certain areas.
Some Tips before the surgery:
-Stop taking blood thinners 5 to 7 days before the surgery.
-Anti-inflammatory medications and certain vitamin supplements can cause increased bleeding, so the surgeon and the anesthetist should be informed about all your medications.
-It’s very necessary to stop smoking few days before the procedure.
-Not eat or drink anything after midnight the night before your surgery, to prevent anesthesia complications.
During a robotic partial nephrectomy:
This procedure is performed under general anesthesia, by making small cuts in the abdomen; so the robotic surgical equipment and camera can be inserted.
Carbon dioxide gas is used to inflate the abdominal cavity to leave space for the manipulation of the surgical equipment and camera to access the cancerous tissues.
While the surgeon is performing the procedure by manipulating the robot, the blood flow to the cancerous kidney is totally stopped; so the kidney can be dissected and the cancerous portion is detached from the tissue. The tumor is totally removed from the body and the surgeon sews the remaining section of the healthy kidney.
After a robotic partial nephrectomy:
– Take analgesics to reduce post-operative pain.
-Walk after a few days of surgery to promote good blood circulation and prevent pneumonia.
-Start with a liquid diet for a few days after the operation.
Robotic partial nephrectomy VS Laparoscopic partial nephrectomy
Robotic partial nephrectomy is more efficient than laparoscopic partial nephrectomy because the da Vinci surgical system has a lot of advantages.
Dr. Fouad El Khoury is currently a Consultant Urologist specializing in Uro-Oncology and Robotic Surgery at Saint George Hospital University Medical Center in Beirut. He is also the Scientific Director for the Middle East at ORSI academy (OLV Robotic Surgery Institute) in Belgium (www.orsi.be), the biggest worldwide robotic surgery training center. He serves the educational field through his work as an Assistant Professor of Clinical Surgery at the University of Balamand’s Faculty of Medicine in Beirut. He has authored several scientific papers and is actively involved in national and international meetings and conferences.
For the last seven years, he has mastered minimally invasive genitourinary procedures (Robotic, laparoscopic, and endo-urologic) some of which are featured even in full length on Modern Care Clinic.
What is Robotic Surgery?
Robotic Surgery has been on the rise lately as a revolutionary tool in the field of medicine and surgeries. Its use has become the norm in many countries around the world. The term “Robotic Surgery” mainly refers to the case where surgeries are performed with the assistance of robotic systems allowing surgeons to perform complex operations through very miniature incisions and resulting in a better outcomes and enhanced patient recovery.
Robotic surgery is similar to laparoscopic surgery in the respect that they both use small incisions, a camera, and surgical instruments … Compared to traditional surgery, robotic surgery provides your surgeon with a greater range of motion and precision, which may lead to less bleeding and post-operative pain.
The first Robotic Surgery System to be adopted as a pioneer concept in the field of medicine was the “da Vinci Surgical System”.
How does it work?
The surgeon sits at a computer station and directs the movements of a robot; small surgical tools are attached to the robot’s arms.
– He makes small incisions to insert the instruments into the patient’s body.
– A thin tube with a camera attached to the end of it (endoscope) allows the surgeon to view enlarged 3-D images of the body.
– The robot boots the doctor’s hand movements to perform the procedure using tiny instruments.
Robotic surgeries advantages :
For the patient :
– Surgery with more precision, significantly less pain, less risk of infection and blood loss, earlier discharge from the hospital, less scarring, and shorter recovery; in many cases, better clinical outcomes.
For the surgeon :
– 3D visualization of the inner body enhanced dexterity, greater precision, higher level of proficiency during any operation.
Robotic urologic procedures
Robotic prostatectomy(the most common procedure performed robotically is radical prostatectomy), Robotic cystectomy, Robotic pyeloplasty, Robotic partial nephrectomy, and many other laparoscopic urological procedures that use now DaVinci robotic assistance.
Robot assisted Partial Nephrectomy (RAPN) is a minimally invasive option for patients with small renal masses undergoing Partial Nephrectomy. In this review we provide an update on the oncological safety and renal functional outcomes following RAPN. We also discuss the novel techniques and technological advances that have contributed to the outcomes of RAPN.
For more information, check the following link on Pubmed.
Dr Fouad Khoury: President of the first robotic surgery congress in Lebanon and hosting Professor Alexandre Mottrie, CEO of ORSI academy, the largest robotic surgery training center in the world and President of the EAU Robotic Urology Section.
The Congress was held on the first of March 2016 at Saint George Hospital University Medical Center (SGHUMC) in Beirut and featured multiple lectures on the use of robotic surgery in medicine.
A convention between SGHUMC and OLV hospital in Belgium was signed in order to facilitate patient transfer from Lebanon to undergo Robotic surgery procedures in a referral center under the supervision and care of Dr. Fouad Khoury who was appointed Director of the Robotic Surgery program.
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