robotics in urology

ROBOTICS IN UROLOGY

INTRODUCTION:

Prostatic surgery has become an important component of urologic surgery.  In USA, prostate cancer is the commonest cancer in men. In Malaysia, the incidence of prostate cancer is reported to be less, about 6th commonest cancer in men. The prostatic gland is located deep in the pelvis, behind the symphysis pubis.  Open radical prostatectomy has been technically difficult because of the confined space.  This has been revolutionised with the use of laparoscopic radical prostatectomy, assisted by the Da Vinci robot. 

DA VINCI ROBOTIC SURGERY:

Since the introduction of 2 Da Vinci robots in Malaysia around 2005 (1 in Hospital Kuala Lumpur and the other in Sarawak General Hospital), prostatectomy surgery has been much improved, especially with RALP, Robot Assisted Laparoscopic Prostatectomy.

The robot is actually a “slave robot”, controlled by the operating surgeon in a console. The console is typically placed in a big operating theatre, although theoretically the console can be located in a remote place. This idea was first envisaged to be used by the military and a remote surgeon can operate with the robot and a bedside assistant, at the battle field!

The robotic arms are therefore inserted into the pelvis. The many degrees of freedom allow the robot instruments to be used as if it is the surgeon’s operating hand. 

There is also magnification (about 10 times) and with 2 cameras to give rise to binocular vision.  In addition, the robotic transmission also removes any  tremors from the surgeon’s operating hand.

With magnification, the surgeon is therefore about to preserve more structures. In particular, the nerve on the posterior lateral aspect of both sides of the prostate are preserved, giving rise to better potency and urinary continence as compared to open surgery.

OTHER USES OF THE ROBOT:

As the robot is very expensive (more than RM10 million per robot), the robot can also be used for other pelvic surgery, e.g. gynaecologic, colorectal.  It may also be used for surgery of the upper tract, e.g. pyeloplasties and partial nephrectomy.  This allows intracorporeal suturing to be used with relative ease as compared to pure laparoscopic surgery. 

DISADVANTAGE OF THE ROBOT:

The robot is expensive to purchase.  In addition, each use of the robotic instrument is computerised and is expensive. The robot also needs to be “docked” to the patient. i.e. to be prepared and the robotic laparoscopic pots and instruments need to be inserted and this often takes time in the beginning.

Written by:

Dr Clarence Lei Chang Moh, FRCS Urol, FEBU

Consultant Urologist

email: clarencelei@gmail.com

4 September 2013