Textbook of Robotic
Urologic Surgery.
Release Date: January, 2007
Michael Esposito, Vincent Lanteri & Jeffrey Stock
da Vinci Robotic Surgery
What is the da Vinci Robot?
The da Vinci Robot, also known as the da Vinci Surgical System, was designed by Intuitive Surgical, Inc. as a tool for surgeons to conduct minimally-invasive procedures. Your surgeons at NJCPC&U were instrumental in testing and perfecting the da Vinci Robot in its early stages of development. They have since mastered its use, having performed more than 2000 successful robotic prostatectomies and written a book on Robotic surgery techniques for other doctors.
The da Vinci Surgical System features miniaturized instruments and 3-D cameras which enable your surgeon to make smaller incisions and work with greater precision than traditional, open surgery. Today, robotic prostate surgery has even replaced laparoscopy, which was also less invasive but was typically limited to less complex procedures.
As advanced as this technology is, the robot cannot be programmed to work on its own. Your surgeon is always in control. The robot provides tools that magnify images, optimize your surgeon's view and guide his hands so that the procedure can be accomplished meticulously, with the greatest accuracy.
With the use of the da Vinci Surgical System specifically for robotic prostatectomy and robotic cystectomy, we are able to perform intricate procedures involving the prostate, kidney and bladder and offer our patients the benefits of minimally-invasive techniques:
- Very small incisions mean significantly less pain and shorter hospital stays.
- You're likely to have a quicker recovery and return to regular activities.
- Most importantly, you'll experience the increased potential for better outcomes including:
- nerve and muscle preservation for sexual function
- reduced incidence of incontinence and
- amelioration of cancer.
While the daVinci Surgical System is state-of-the-art technology, not every surgeon is trained and expert in its use. You can rest assured that your surgeons at NJ Center for Prostate Cancer & Urology are the authorities in the NY-NJ region, having performed more than 2000 successful robotic prostatectomies than any other team in the state – with a zero percent mortality rate. More experience makes for better outcomes.
For Prostate Cancer
Patients have common concerns about traditional "open" radical prostatectomy, the prostate surgery which typically requires a large incision so that the surgeon can access and see the gland, organs, nerves, and blood vessels. The invasiveness of the procedure generally requires a longer recovery, involves more pain and has a higher risk of complications including infection.
The da Vinci Surgical System enables surgeons to perform a radical prostatectomy using minimally invasive techniques. The robotic system enhances the surgeon's range of motion, precision and dexterity - all crucial in the complex anatomy surrounding the prostate gland. The operation is performed through five incisions no wider than a dime. Your surgeon inserts a pencil-size binocular telescope into an incision to provide magnified, 3-dimensional images of the surgical site. The view is comparable to the one a surgeon has during open surgery, but without the invasiveness of the older procedure. The da Vinci robot translates the large hand movements of the surgeon into precise, minute movements inside the patient. Tiny, exact sutures can mean the difference between incontinence and normal urinary function. Precise moves in hard-to-maneuver areas also enable your surgeon to spare nerves that preserve sexual function.
Most importantly, studies have shown that the most experienced surgeons - like your surgeons at NJCPC&U who have conducted more than 2000 robotic prostatectomy procedures using the da Vinci robot – have achieved excellent results in removing prostate cancer without leaving cancer cells behind. In other words, as a prostate cancer treatment, robotic prostate surgery is effective cancer control.
Additional benefits include:
- Less blood loss
- Less pain
- Less scarring
- Quicker recovery time
- Faster return to your routine activities
For Bladder Cancer/Cystectomy
Bladder cancer is typically diagnosed using a combination of urine tests, specialized x-rays and cystoscopy with biopsy. Treatment is determined by the type and developmental stage of the cancer. The robotic cystectomy is a minimally invasive bladder surgery for the treatment of invasive cancer. NJCPC&U's use of the da Vinci Robotic Surgical System offers bladder cancer patients an effective procedure to remove the cancerous bladder with smaller incisions and less problematic post-surgical outcomes as compared to open surgery, including less blood loss and lower transfusion rates. The magnification offered by the robotic system facilitates better precision during the procedure, thus, sparing vital delicate nerves and muscle tissue. The use of the da Vinci robot also provides our surgeons with more surgical dexterity during bladder removal and urinary tract reconstruction. With robotic cystectomy, NJCPC&U patients have had excellent cancer cure rates, as well as comfort and overall satisfaction.
Following removal of the urinary bladder one of three methods of urinary reconstruction may be utilized to allow urine an exit from the body called urinary reconstruction. In discussion with the patient the surgeon will take into account the patient's unique situation. The three methods are:
- Ileo-conduit - A simple urine diversion method using a small segment of intestine to allow urine to exit through a small stoma located to the right of the umbilicus. This diversion requires use of an external urine collection device/bag.
- Indiana pouch - A continent urinary diversion. A more complex reconstruction creating a reservoir to collect urine inside the body with a small skin stoma that requires catheterization to empty. The stoma is located usually next to or in the umbilicus. May cover with a bandaid. These patients do not require use of an external urine device/bag.
- Orthotopic neobladder - A continent urinary diversion in which a new bladder is constructed and reconnected to the urethra. Voiding will be via normal method from urethra. These patients do not requite an external urine collection device/bag.
The benefits of robotic cystectomy:
- Spares vital muscle and delicate nerve tissue
- Shorter hospital stay
- Faster return to normal activity
- Minimal blood loss
- Minimized chances of post-operative incontinence or impotence
- Minimized chances of complications commonly associated with cystectomy
- Minimal post-operative pain
For UPJ/Pyeloplasty
Pyeloplasty is a kidney surgery to reconstruct a malformed or congenitally obstructed ureter connected to the renal pelvis. A robotic pyeloplasty is the precise removal of an obstruction in the ureter leading from one of the kidneys to the bladder (ureteropelvic junction or upj). The UPJ is the portion of the collection system that connects the renal pelvis to the ureter. If the transition from the renal pelvis to the ureter is narrow/tight, the urine will not drain easily. This obstruction leads to progressive dilatation of the renal collecting system and can result in pain and progressive deterioration of kidney function.
Robotic pyeloplasty was developed as a minimally invasive alternative to an open procedure for the treatment of ureteropelvic junction obstruction. Robotic pyeloplasty maintains the advantages of the traditional open technique, while minimizing the risks of a large flank incision. The main advantages of robotic pyeloplasty over traditional open technique are a shorter hospital stay and quick return to daily activities. Unlike open pyeloplasty, the robotic procedure will not leave a large, permanent, disfiguring scar. Robotic pyeloplasty makes suturing of the ureter easier, which makes the procedure safer, as well as effective.
For Kidney Cancer/Partial Nephrectomy
Surgery is the initial treatment for the majority of kidney cancers. A nephrectomy is a kidney cancer treatment to surgically remove the affected kidney.
The da Vinci Surgical System enables surgeons to perform three types of robotic nephrectomies: partial, simple and radical. A partial, robotic nephrectomy is a procedure to remove a small tumor from the kidney, without removing the entire kidney. A simple, robotic nephrectomy is the total removal of a kidney when it becomes a chronic problem or loses its function. A radical, robotic nephrectomy is the removal of the kidney with all the surrounding fat, fascia and the adrenal gland.
The da Vinci robot allows the surgeon to employ great precision in disconnecting large blood vessels from the kidney - a vital part of the operation – while utilizing minimally invasive techniques. The benefits to patients include:
- Less blood loss
- Less risk of infection
- Much less pain
- Less scarring
- Quicker recovery
- Increased potential for kidney preservation in certain prescribed cancer operations
- Better kidney cancer survival in many cases
For Incontinence/Sacral Colpopexy
Sacrocolpopexy is performed for those patients with a dropped or poorly suspended uterus or uterine prolapse. These patients often undergo hysterectomy. For younger women or those not desiring to undergo hysterectomy, a sacrocolpopexy may be performed to recreate the normal suspended uterus without the need for removal. This is performed with robotic assurance thus is performed in a minimally invasive technique.
Any urinary incontinence that accompanies the uterine prolapse will be addressed and corrected with a small transvaginal sling during the same operation.
Ureteral Stricture/Reimplant
The ureters are tubes that carry urine from your kidneys to your bladder. A ureteral stricture is a narrowing of the ureter that results in an obstruction of the flow of urine. An unattended obstruction can cause kidney failure. Treatment traditionally has involved endoscopic surgery, wherein a ureteral stent is inserted to drain urine into the bladder. However, this is not a permanent solution as the stent must be changed every few months. More permanent solutions have traditionally been done requiring open surgical repair.
If you are seeking a state-of-the-art repair to a ureteral stricture, you should speak with the doctors of NJCPC&U about Robotic Ureteral Reimplantation, a minimally invasive surgery to reconstruct the ureter. With NJCPC&U's expertise in using the da Vinci Robot, this procedure can provide you with a more comfortable and effective alternative. Patients generally experience a brief hospital stay and quicker recovery than with open surgery.
For BPH/Simple Prostatectomy
If your family doctor has concluded that your benign prostatic hyperplasia (BPH) or lower urinary tract obstruction cannot be treated adequately by medication and if prostate cancer has been ruled out, you may be a good candidate for minimally-invasive surgery. NJCPC&U offers Robotic Simple Prostatectomy as a safe and effective treatment for BPH.
For patients who have very large prostate glands (usually those measuring over 150 grams), Simple Robotic Prostatectomy is a state-of-the-art treatment to remove the portion of the prostate causing the obstruction. The procedure counters the discomfort and risks of open surgery with significant benefits, including:
- Shorter hospital stays (1-2 days compared to up to a week)
- Less pain and minimal blood loss
- Quicker recovery and return to routine activities