Primer

Emerging Role of Robotics in Urology

Robotic urologic surgery is an exciting and new emerging frontier in the field of urology.

The picture shows a robot docked over the patient and an assistant watching on the screen, as the surgeon performs the surgery away from the patient

Robotic surgery is an advanced version of laparoscopic surgery, wherein a robot is used to manipulate the surgical instruments, while the surgeon controls the robot's movements. The use of robot assistance for surgery for prostate cancer is a state-of-the-art technology, and is available at select centers worldwide. The robot allows extreme surgical precision, thus minimising the incidence of post-operative pain and complications. This surgery has many advantages to the patient and also to the surgeon who performs this.

The one and half century of surgeries included surgery for cancer of the prostate, bladder cancer, kidney cancer, urinary fistulae in females, beside various surgeries for benign diseases such as blocked kidney and also in diseases afflicting children.

Emerging Frontier

Dr Ashok K Hemal

Robotic urologic surgery is an exciting and new emerging frontier in the field of urology. This has tremendous potential to progress in the future from its current status. Therefore, it is important to keep abreast of the new technologies, their limitations, and the possibility of incorporating it in day-to-day surgery. There are now substantial number of reports on performing complex urological procedures with robotic assistance in humans in the literature documenting their safety, efficacy and feasibility.

Most of the recent reports pertaining to robotic surgery have been in the domain of localised cancer of the prostate (radical prostatectomy), bladder cancer (radical cystectomy and urinary diversion for muscle invasive bladder cancer), kidney surgery (nephrectomy, donor nephrectomy and pyeloplasty), and adrenal surgery.

The Development

With the potential advantages and latent qualities of robotic-assistance in minimal invasive surgery over conventional surgery, robot-assisted surgeries may be developed to the next level and lead to future revolution of the way surgeries are performed. The robot-assisted radical prostatectomy in the management of localised cancer prostate is one such example. Future application may also allow integration of pre and intra-operative imaging in management of disease. The impact of robotics in urological surgery is therefore very promising, as also cautious worldwide interest can be appreciated in this area. The real issue is not do we really need it, but it should be accepted as a new developmental leap in the area of minimal invasive surgery for performing complex surgical procedures. However, controlled clinical trials and comparisons from various centers are the need of the hour. Other important concerns are the cost, training and development of a new generation of smaller machines.

AIIMS is now running various studies to evaluate and analyse robotic surgery's utility in Indian perspective as the cost of machine and disposables are exorbitant. Hitherto, all such surgeries were performed laparoscopically or with conventional open surgery.

Advantage Robot

Three major advances aided by surgical robots have been advancement of laparoscopy, remote surgery, and minimally invasive surgery. Advantages to surgeons from robotic surgery include enhanced 3-D visualisation, improved dexterity, greater surgical precision, improved access, and increased range of motion. For patients, major potential advantages of robotic surgery are precision and miniaturisation. Further advantages are articulation beyond normal manipulation and three-dimensional magnification. Also, the pain and trauma to the body is reduced and the use of anaesthesia is less. There is less blood loss and need for transfusions is also lower. In addition, there is less post-operative pain and discomfort, and minimal risk of infection.

The hospital stay is shorter and scarring is less. Also, the comesis is improved. Faster recovery and return to normal daily activities are also added advantages.

Although the advantages overrule the concerns, there are a couple of things that medicos worry about. One of them is that the current equipment is expensive to buy and maintain. Also, at this point in time, there is only one company which makes the robot.

The writer is Professor, Department of Urology, All India Institute of Medical Sciences, New Delhi