Using Robots in Urology

The word “robot” was coined by a Czech playwright almost a century ago, derived from “robota,” meaning “forced labor.” Now used routinely, robotics represents a significant engineering advance that has been rapidly adopted by urologists since its inception 15 years ago.  Before the availability of this technological breakthrough, major urological surgical procedures were performed through large incisions with poorer visualization, more blood loss, less precision, more pain and longer hospital stays and recovery.

With the advent of laparoscopy (“keyhole”) surgery done via small portals and thereafter the development and refinement of surgical robotics, many advantages have accrued. Major surgical procedures can be performed less invasively, with a reduction in blood loss, a brighter, sharper and magnified visual field for the surgeon, less pain and faster recovery. The robot has been put to use for prostate, bladder, kidney and adrenal surgery as well as for severe cases of female pelvic organ prolapse. Robotic technology has been beneficial in helping urologists remove diseased organs as well as in facilitating reconstructive urological procedures. Robots do not perform the surgery independent of the surgeon!  The urologist with a dedicated team of assistants harnesses the powers of the robot for the benefit of the patient, the robotic technology an extraordinary example of human-machine symbiosis.

The operative field with robotic instruments mounted on robotic arms

The operative field with robotic instruments mounted on robotic arms

Initially, portals are placed by small incisions that leave only small scars and cause limited pain. Through one of these portals, a camera is inserted to obtain an optically magnified, three dimensional, high definition view of the surgical field. The camera can be manipulated, zoomed, rotated, etc. Robotic instruments that are mounted on the robot’s arms are inserted through the portals. These include electric cautery used to cut and coagulate tissue, scissors, forceps, scalpels, needle holders and other surgical tools.

The surgeon sits at a console remote from the patient and controls and maneuvers the miniaturized robotic instruments while viewing the operation in real time. An advantage of sitting at the console is that it is a very comfortable, ergonomically favorable position that minimizes the postural fatigue that often accompanies standing up for traditional open surgery. The surgeon’s fingers are inserted into surgical joysticks that provide control of the instruments by using natural hand and wrist movements, with the system capable of “motion scaling,” converting the surgeon’s movements to precise, tremor-free robotic micro-movements.  In addition to hand controls the surgeon uses foot pedals to control the camera, focus, electro-cautery and coagulation.  Seven degrees of freedom (each direction a joint can move is a degree of freedom) are provided at the instrument tips. 540 degrees of pivoting provide greater maneuverability than is possible with the human hands or laparoscopic instruments.

Dr. Mutahar Ahmed seated at the console performing a robotic prostatectomy

Dr. Mutahar Ahmed seated at the console performing a robotic prostatectomy

 

Robot-assisted laparoscopic prostatectomy is the surgical approach of choice for removing a cancerous prostate gland, allowing the surgeon the benefits of markedly better vision and maneuverability, very refined precision in the dissection of delicate tissue and facilitation of suturing. Because of these advantages, in addition to less bleeding, less post-operative pain and shorter hospital stays, there are improved outcomes in terms of urinary incontinence and erectile dysfunction as compared with the open approach.

Bottom Line: Surgical robotics is a revolutionary technological advance that has been rapidly adopted by urology, general surgery, gynecology, cardio-thoracic, pediatric and ear-nose-throat surgeons. It affords numerous advantages including surgeon comfort and ergonomics, high quality 3D vision, motion scaling, enhancement of surgeon dexterity and elimination of tremors, which translates to numerous benefits and advantages to the patient.

By |January 28th, 2016|Uncategorized|1 Comment

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  1. Alex Trodder February 2, 2016 at 7:48 pm - Reply

    I know that many people can be scared about how robots can play an increasing role in surgical procedures. However, you make the great point that the urologist or other specialist is still the one that operates the equipment. Additionally, the fact that surgeons can scale down movement sensitivity can help surgeons perform procedures like nerve and vessel repair because of the improved ability for suturing. Thanks for your informative article.

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