Robotic Surgery for Urology Treatment: A Game changer for Patient care by Dr. Amit Goel

With the growing population, urological complications have been increasing, too. In my two decades of experience, cancer of different organs, including the kidney, prostate gland, urinary bladder, and testis, are some of the commonly seen urological issues. 

Kidney cancer, which accounts for 1.3% of India’s total cancer cases, like any other urological complications, if not detected and treated on time, can become life-threatening. 

Another critical concern is end-stage kidney disease, ESRD, a condition where the kidneys lose their ability to filter blood properly, ultimately requiring a kidney transplant.

Now, imagine recovering from a urological surgery with minimal pain and shorter hospital stay. This is now a reality all because of robotic surgery. Let’s understand robotic surgery in detail.

Overview of Robotic da Vinci Xi Surgical System

Surgical technology is undergoing a revolution, with procedures becoming less invasive and more precise than ever before.

Robotic da Vinci Xi is one of the advancements now available at Max Hospital, Gurgaon. This minimally invasive procedure allows for high-precision urological surgery. 

The mention of robots in the medical field sounds exciting. Whenever I discuss robotic surgery, patients assume that a robot will perform the surgery with all essential equipment and surgeons will monitor the entire surgical procedure. 

But actually, it doesn’t work like that. 

In reality, surgeons themselves perform the procedure. The difference is that instead of directly operating patients with our hands, we control robotic arms with the help of a state-of-the-art Robotic console placed near the operating table. The movement is translated into the patient by the Robotic arms to perform the surgery. 

The system is equipped with hand controls and foot pedals to direct different parts of the instruments. Additionally, it contains a stereo viewer that allows surgeons to view high-quality images of the surgical field. 

There is a facility for a surgeon to communicate with the patient as well as their assistant via speaker and microphone. 

We have employed Robotic- Da-Vinci Xi to treat various urological cancer conditions, which include prostate cancer (Radical Prostatectomy), bladder cancer (Radical Cystectomy), ureter cancers (Nephroureterectomy with bladder cuff excision ), kidney tumours (Partial and Radical Nephrectomy), testis cancer (Retroperitoneal Lymph node dissection), adrenal tumour (Adrenalectomy) and Excision of Retroperitoneal tumours.

We also use this technique to perform benign conditions like end-stage Kidney failure (Kidney Transplantation), PUJ obstruction (Pyeloplasty), ureteric stricture/obstruction (Ureteric Reimplantation), and many other complex urologic reconstructive procedures.

Robotic da Vinci Xi: Step-by-Step Procedure

Now that we have an overview of the Robotic da Vinci Xi system, patients need to understand what actually happens during the procedure. Let’s simplify it.

Preparation and positioning of the patient

The patient is carefully positioned on the patient cart of the da Vinci surgical system, based on the surgeon’s preference.

Robotic draping

To create a sterile environment during the surgical procedure, both the patient’s cart and the vision cart are sterilised and then draped to maintain an aseptic environment. This step is done to prevent infections during the procedure.

Robotic port placement

After accessing the peritoneum, an endoscope and other necessary ports are positioned to reach the targeted organ accurately.

Robotic docking on the patient

With the patient positioned, the robotic surgeon begins by docking the camera arm. Using a clutch button, the camera arm is angled to precisely target the surgical site. Instrument arms are then positioned to allow maximum range of motion. These arms are designed with seven degrees of wrist movement for enhanced precision.

After securing the camera and instrument arms, the patient’s position should remain unchanged.

Positioning of the urological surgeon

The surgeon then positions their head in the stereo viewer console near the patient's operating table, allowing them to control micromovements with precision. A key safety feature of the stereo viewer is that the machine remains inactive if the surgeon is not looking inside it. This gives the surgeon complete control over surgery.

Surgical procedure

Then, by viewing the live 3D imaging, we perform the surgical process by controlling the arms with the console.

After the surgery is completed, the surgeon carefully removes the console and ports, step by step, ensuring a safe conclusion to the procedure.

Why is Robotic da Vinci Xi a preferred approach?

Robotics allows us to do things during surgery that were not possible earlier. Below are some of the remarkable benefits of this innovative technology.

• Surgeons now have the freedom to perform micro-movements with seven degrees of motion, which was beyond our capabilities even after years of experience.
• Since we are making minimal incisions, the chances of blood loss are also minimal. As a result of this,the time of wound healing would be reduced.
• Fewer incisions also mean minimal pain and no post-surgery restrictions for patients.
• Post surgery, proper suturing of the incisions is done.

With all the advantages stated above, we consider that this innovative surgical breakthrough has significantly enhanced the patient’s quality of care.

Understanding Limitations

While robotic surgery offers significant advantages, it’s important to recognise that it’s not a standard solution. Not all patients are suitable candidates, and not all urological diseases can be treated with this technology.

Feasibility of surgery needs to be evaluated by the surgeon. Even within a specific condition like prostate cancer, there may be rarely certain factors that make robotic surgery less appropriate.
Moreover, surgeons need to be guided and trained on the console and arms before operating the system. With time, more surgeons will adapt to this approach, and we will be able to achieve greater precision with it.
However, as robotic technology advances and more surgeons gain expertise, we can anticipate improved outcomes for a broader range of patients with urological conditions.

Conclusion

The possibilities with robotic surgery in treating urological cancers are endless. As technology continues to advance, we can only imagine the incredible breakthroughs that will come. As a urologic surgeon, I'm excited to be part of this medical revolution and to help more patients benefit from this life-changing treatment.