Urologic Robotic Surgery


Cystectomy

Cystectomy is a medical term for surgical removal of all or part of the bladder. The most common condition warranting removal of the urinary bladder is bladder cancer. After the bladder has been removed, a urinary diversion surgery is necessary.

Robotic surgical systems have thrust minimally invasive surgical options into a new era. For years, surgeons and urologic oncologists have relied on the minimally invasive, nerve-sparing virtues of the procedure known as laparoscopic cystectomy to offer their patients the most effective treatment for bladder cancer. Not long ago, all cystectomies were performed using an open surgical procedure in which notable tissue and nerve damage, significant blood loss, and an increased risk of post-operative infections and complications were common.

Robotic cystectomy is simply a newer, more effective, minimally invasive surgical method for bladder cancer. This procedure utilizes the da Vinci Surgical System in which a robotic arm imitates the surgeon’s movements, amplifying their precision. It offers bladder cancer patients the prospect of a more effective surgery and less problematic post-surgical recovery. It is fast becoming the preferred answer for bladder cancer surgery. This surgical procedure allows the surgeon to make smaller incisions which spare vital, but delicate, nerve and muscle tissue. The patient experiences a shorter hospital stay, fewer complications, and a faster recovery time.

The da Vinci Surgical System provides the physician with a superior visualization plane and improved surgical dexterity during bladder removal and, if necessary, a reconstructive procedure.

By offering the surgeon, urologist or oncologist a high-definition 3-D view, the da Vinci surgical robot distinguishes the vital muscles and delicate nerve tissues surrounding the operative area, providing the opportunity to preserve them. The robot’s unique EndoWrist instruments offer physicians the dexterity not available to them when using conventional laparoscopic instruments. By taking advantage of the da Vinci robot, surgeons are able to dissect and reconstruct the bladder with relative ease.

Benefits of Robotic-Assisted Cystectomy:

  • Minimal damage to vital muscle and delicate nerve tissue as a result of the surgery.
  • A shorter hospital stay and an even faster return to a normal level of activity.
  • Fewer noticeable scars.
  • Minimized risk of blood loss.
  • Minimized chances of post-operative infections.
  • Minimized chances of post-operative incontinence or impotence.
  • Minimized chances of other complications commonly associated with cystectomy.
  • Minimal post-operative pain and discomfort.
  • The unprecedented technology of the da Vinci Surgical System which offers surgeons, oncologists and urologists a high-definition, three-dimensional view of the procedure, as well as the assistance of the robot in suturing.

Robotic-assisted cystectomy offers patients a 14% higher cancer removal rate compared to traditional surgery. The da Vinci procedure improves the chances of re-establishing normal sexual activity in as little as 11 months.

Nephrectomy

If your doctor recommends surgery to treat renal cancer, you may be a candidate for a safe, effective and minimally invasive procedure – da Vinci Surgery. Using the most advanced technology available, da Vinci Surgery provides your doctor with superior vision, precision, dexterity and control. A da Vinci nephrectomy (removal of the section of the kindney containing the tumor) allows for improved access inside the abdominal cavity.

A nephrectomy using the da Vinci Surgery system is performed through a few tiny incisions that access the abdomen. da Vinci is minimally invasive, unlike a traditional laparotomy.  In performing a laparotomy, the surgeon accesses the abdominal cavity through a long incision – often creating a long and painful recovery period for the patient.

A da Vinci nephrectomy offers renal cancer patients the benefits of surgery, but with a minimally invasive approach. Those potential benefits include:

  • Low cancer reoccurrence, mortality in advanced disease
  • Minimal pain, including low postoperative neuralgia (pain caused by nerve damage)
  • Low blood loss
  • Few complications
  • Fast return of pulmonary function
  • Short hospital stay
  • Fast recovery

The da Vinci Surgical System is designed to provide surgeons with enhanced capabilities, including magnified, high-definition, 3D vision. Your doctor controls the da Vinci System, which translates his or her hand movements into smaller, more precise movements of tiny instruments inside your body. Though it is often called a “robot,” da Vinci cannot act on its own. The surgery is performed entirely by your doctor.

Together, da Vinci technology allows your doctor to perform complex procedures, such as a nephrectomy, through just a few tiny openings. As a result, you may be able to get back to normal activities faster — without the usual recovery following major surgery.

The da Vinci System has been used successfully worldwide in hundreds of thousands of procedures to date.

As with any surgery, these benefits can not be guaranteed, as surgery is specific to each patient and procedure. Before you decide on surgery, discuss treatment options with your doctor. Understanding the risks of each treatment can help you make the best decision for your individual situation.

Partial Nephrectomy

da Vinci partial Nephrectomy offers a safe, effective approach to minimally invasive nephron-sparing surgery, with the potential for improved clinical outcomes and patient comfort. da Vinci partial Nephrectomy may allow:

  • Excellent renal mass dissection and excision
  • Easy and precise intracorporeal suturing for renal reconstruction, facilitating procedure completion with reduced warm ischemia times
  • Real-time intraoperative ultrasound guidance and auxiliary video input display using TilePro™ multi-image display
  • Shorter operative time compared to laparoscopic partial nephrectomy

Prostatectomy

You may be a candidate for a less invasive approach to prostate removal called robotic prostatectomy. This method incorporates the latest advancements in robotic-assisted technology and allows a surgeon greater visualization, enhanced dexterity, precision and control

For qualified candidates, the robotic prostatectomy offers numerous potential benefits over the traditional open prostatectomy, including:

  • Better retention of bladder control
  • Better retention of erectile function
  • Shorter hospital stay
  • Less post-operative pain and pain medication
  • Less anesthesia
  • Less blood loss and transfusions
  • No blood donation necessary from patient
  • Less scarring
  • Faster and more complete recovery
  • Quicker return to normal daily activities

Pyeloplasty

uretero-pelvic junction obstruction Drawing of a swollen kidney that results from uretero-pelvic junction obstruction

Pyeloplasty is the surgical reconstruction or revision of the renal pelvis to drain and decompress the kidney. Most commonly it is performed to treat an uretero-pelvic junction obstruction if residual renal function is adequate.

This revision of the renal pelvis treats the obstruction by excising the stenotic area of the renal pelvis or uretero-pelvic junction and creating a more capacious conduit using the tissue of the remaining ureter and renal pelvis.

Ureteral Re-Implantation

After the kidneys make urine, the urine passes down a tube called the ureter to the bladder where it is stored until elimination. The place where the ureter inserts into the bladder is called the ureterovesical junction. Sometimes this junction does not form properly before birth and, as a result, urine travels back up toward the kidney instead of down and out of the bladder as the bladder squeezes and tries to empty. This is called vesicoureteral reflux and is often diagnosed in childhood after recurrent urinary tract infections or kidney infections.

Surgical repair may be necessary if long-term antibiotics or bladder injections are ineffective. This surgery is called ureteral reimplantation and in appropriate patients can be performed as a minimally invasive robotic-assisted surgery.

Ureteral reimplantation may be required in adults for reasons other than reflux. The ureter (kidney tube) may be damaged during another surgery in the belly. If the ureter is damaged, it may be possible to reattach the ureter to the bladder with ureteral reimplantation.

Saint Thomas West Hospital's state-of-the-art da Vinci® robotic surgical system allows your doctor to perform a precise, minimally invasive procedure through a few tiny incisions with enhanced vision, dexterity and control.

Benefits of robotic-assisted surgery over open surgery include: Significantly less pain, less blood loss, fewer transfusions, lower risk of infection, less scarring, shorter hospital stay, shorter recovery time and better clinical outcomes, in many cases.

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