Robotic surgery involves use of the da Vinci robot surgical unit in performing complex surgeries. Although Robot is used in multiple specialities for minimal invasive surgeries, urologic oncological surgical procedures are at forefront of the spectrum. Other specialities where Da Vinci robot has commonly been used include (but not limited to) gynaecological malignancies, thoracic procedures and bariatric surgeries. Urological cancer surgeries in which Robot is used include Robotic Radical prostatectomy (removal of the prostate gland usually for cancer), Robotic partial nephrectomy (surgical removal of tumor of kidney while preserving the normal part of kidney), Robotic Radical Cystectomy with Urinary diversion (Removal of cancerous urinary bladder while constructing the pathway for urinary passage by using part of intestines), Robotic Radical Nephrectomy (removal of whole of cancerous kidney when part of it can’t be saved), Robotic Nephroureterectomy and Robotic Adrenalectomy. Other major Uro-oncological procedures include Robotic Retroperitoneal lymph node dissection (for residual tumor in abdomen usually after chemotherapy for testicular tumor) and Robotic VEIL (video endoscopic ilioinguinal dissection). This exciting technology allows the operating surgeon to sit comfortably behind a console and control the robot that is next to the patient to perform surgery. The operating surgeon sitting on master console is in complete control of robotic instruments attached to robotic arms that have been docked to ports placed in patient’s abdomen. An experienced assistant surgeon assists the console surgeon from the bedside.
Most patients and physicians would agree that minimally invasive surgery is preferred over traditional open surgery techniques. All minimally invasive surgery techniques have similar benefits, such as less blood loss, reduced pain, smaller scars, shorter stay in the hospital and faster recovery times. However, sometimes patients have the choice between two minimally invasive surgery techniques: robotic surgery and laparoscopic surgery. There are some technical limitations to laparoscopic surgery which can make it difficult even for an experienced surgeon to work in certain scenarios. On the contrary, the technical advances with robotic surgery has enabled the surgeon to conduct surgery with previously unmatched precision under high-definition, magnified 3D vision.
Advantages of Robotic Surgery over Laparoscopic Surgery
| Variable | Robotic | Laparoscopic |
| Vision and image | 3D, magnified, high definition leading to increased accuracy and vision | Usually 2D |
| Who controls the Camera | Primary Surgeon | Assistant |
| Max number of instruments under control of primary surgeon(Main operating surgeon) | Can control four instruments including camera, hence better coordination | Only two instruments and hence dependency on assistant increases |
| Range of motion of instruments | Greater range of motion and hence precision | Limited range of motion |
| Level of dexterity | Highest possible; Robotic instruments can rotate a full 360 degrees and more flexible than a human hand or wrist | Limited range of motion |
| Ability to access hard to reach spaces | Incomparable; Robot can allow the surgeon to reach and operate in otherwise inaccessible areas | Much lesser than robotic |
| Suturing (stiches inside the body) | Much easier and faster reducing bleeding and surgical time | Much more time consumng and difficult, can affect the precision and surgical results |