What is urologic robotic surgery?
Robotic-assisted surgery in urology combines advanced technology and human surgical skill. A surgeon sits at a console near the patient. The surgeon controls the robotic arms from the console to perform precise procedures while viewing the surgical site on a screen.
The robotic technology system features a high-definition 3D camera that provides magnified views of the inside of the body. Special instruments can also bend and rotate with greater flexibility than human hands. The other members of the medical team assist at the patient’s side.
The development and introduction of the da Vinci® surgical system in the late 1990s proved to be a watershed moment in robotic urology surgery procedures.
How is robotic surgery used in urology?
In urology, robotic surgery is now used for most surgeries, including:
- Robotic prostate surgery, such as a prostatectomy (prostate removal)
- Kidney surgery (including partial and complete nephrectomy)
- Bladder cancer, including removal (cystectomy)
- Some kidney blockage surgeries, such as pyeloplasty, ureteral reimplantation, and ureteroureterostomy
- Reconstructive procedures like pyeloplasty
- Pelvic organ prolapse
- Enlarged prostate
- Genitourinary fistula
What are the benefits of urological robotic surgery?
Since robotic surgery is much more minimally invasive than traditional “open surgery,” there are many benefits. These include smaller incisions, less blood loss, reduced pain, shorter hospital stays (patients can usually go home after one night in the hospital, rather than four to seven days), and a faster recovery.
For procedures like prostate cancer surgery, robot-assisted prostate surgery often allows for better preservation of urinary control (less leakage and urinary incontinence) and better sexual function (less erectile dysfunction). This is because the surgeon can better spare critical nerves and structures.
Who is the ideal candidate for robotic surgery?
If a patient is fit for surgery, we almost always recommend robotic surgery unless there is a clear indication that an open approach is needed. Open surgery is often required if a patient has had many prior surgeries in the same anatomic (body) area. This would make a robotic approach too difficult or unsafe. Otherwise, we almost always perform the needed surgeries with a robotic-assisted approach.
How is robotic surgery performed?
After the patient is put to sleep with general anesthesia, the abdominal cavity is filled with gas to create a working space. A few small incisions (cuts) are made. The robotic arms work through these incisions. The surgeon sits at a console in the room to control the robot.
What is the success rate of robotic surgeries?
Robotic surgery is at least as successful, and in some cases, more successful than the traditional open approach. Plus, using urological robotic surgery significantly eases recovery.
What are the risk factors of robotic surgery?
Like all surgeries, robotic surgery involves a risk of bleeding and infection. There is always the remote chance that the surgery cannot be completed robotically or that an emergency will require converting the procedure to the open approach.
What is the recovery after robotic surgery like?
Most patients are discharged home within 24 hours after undergoing robotic surgery. While the surgery will still result in some pain, it is less painful than open surgery. The recovery process is generally “night and day” different from open surgery. Patients are often pleasantly surprised by how smooth their recovery is compared to other surgeries they may have had in the past.
Why don’t all urological surgeons perform robotic surgeries?
This is due to their lack of experience. The surgical tools used in robotic surgery have a very steep learning curve. It takes many hours of practice over many days before a surgeon is qualified. There are many training options available, but each requires dedication and a significant amount of time.
Formal training for robotic and laparoscopic surgery
Surgeons who perform robotic and laparoscopic surgery undergo extensive formal training through structured pathways. At Tower Urology in Los Angeles, surgeons like Dr. Susan Rusnack have completed specialized fellowship training in laparoscopic and robotic surgery following their urology residency. Formal training typically includes:
Residency training: Many surgeons receive foundational training in laparoscopic and robotic techniques during their residency. The Residency Review Committee (RRC) sets minimum requirements for basic and advanced laparoscopic procedures that residents must complete.
Fellowship programs: Specialized post-residency fellowships provide intensive training specifically in robotic and laparoscopic techniques. For example, Dr. Rusnack completed a dedicated fellowship in laparoscopic and robotic urology at Mount Sinai School of Medicine.
Structured curricula: For surgeons without residency/fellowship training in robotics, structured curricula are required, including:
- Didactic education on specific technology
- Hands-on training in dry lab environments
- Experience with specialty-specific models (animate, cadaveric, virtual reality)
- Observation of live cases
Certification programs: Many surgeons complete certification programs, such as:
- Fundamentals of Laparoscopic Surgery (FLS) – a comprehensive web-based education module with 13 chapters covering equipment, patient preparation, and technical skills.
- Fundamentals of Robotic Surgery (FRS) is an online program on robotic surgery principles developed by experts.
Ongoing clinical experience: After initial training, surgeons must perform procedures under expert supervision until they demonstrate competency. This typically involves:
- Initial clinical experience under review by an expert
- Mentored procedures with a preceptor or proctor
- Formal assessment of competency
Tower Urology’s physicians, including specialists like Drs. Among others, David Josephson and Dudley Danoff have extensive educational backgrounds from prestigious institutions, including Yale University School of Medicine and Columbia-Presbyterian Medical Center.
Due to the intense training requirement, complication rates are typically higher during a surgeon’s early cases. If a surgeon has performed less than 20 robotic surgeries, their operative outcomes (operation results) will most likely be “acceptable.” Achieving favorable surgical margin rates usually requires experience with over 80 cases. So, you want a surgeon with extensive expertise in robotic surgery. Tower Urology has multiple fellowship-trained urologists with decades of cumulative expertise in robotic surgery.
Tower Urology, Los Angeles’s experts in robotic urological surgery
We take a personalized, evidence-based approach to general urology care at Tower Urology. All our professionals at Tower Urology are committed to giving you expert care and follow-up. We take the time to understand you and personalize your treatment plan to your needs.
We invite you to establish care with Tower Urology.
Tower Urology is conveniently located for patients throughout Southern California and Los Angeles, including Beverly Hills, Santa Monica, West Los Angeles, West Hollywood, Culver City, Hollywood, Venice, Marina del Rey, Burbank, Glendale, and Downtown Los Angeles.
Our services include treatment for incontinence/overactive bladder (OAB), hematuria, urinary tract infections, nocturia, kidney stones, and urinary bladder dysfunction.
Robotic Urological Surgery FAQs
Based on the search results, the most common robotic urologic procedure is the robot-assisted radical prostatectomy (RARP). This procedure has become the surgical treatment option of choice for radical prostatectomy in well-resourced countries. Recent data shows that in the U.S., “robotic-assisted laparoscopic prostatectomy accounts for 80%-90% of all prostatectomies performed.”
Yes, traveling is allowed after robotic prostatectomy, but the timing and recommendations vary depending on the type and length of travel:
Short-term travel (Days after surgery): Some medical centers suggest that patients can travel by car or plane as soon as two days after the procedure. However, this guidance varies significantly between healthcare providers and individual patient circumstances.
Catheter considerations: Most medical professionals recommend waiting until your catheter is removed before travel. Catheter removal typically occurs 7-10 days after surgery. Many patients prefer to stay near their surgical center until the catheter is removed to ensure proper medical care if complications arise.
Travel recommendations for car travel: Below are some guidelines:
- Short drives (under two hours) are generally permitted soon after discharge.
- For longer trips (like 600 miles), many patients wait at least 12-30 days post-surgery.
- Plan frequent stops every 2-3 hours to walk around and prevent blood clots.
- Consider using maximum absorbency pads and a portable urinal bottle
(especially helpful if restrooms aren’t nearby or during traffic delays).
Robotic surgery significantly improves outcomes in urological procedures through several key mechanisms:
Enhanced surgical precision: Robotic surgery systems provide surgeons with unparalleled precision during complex urologic procedures. The technology allows for:
- Extremely small, controlled movements that humans couldn’t achieve alone.
- Enhanced dexterity and flexibility beyond the natural limits of human wrists.
- High-definition, magnified 3D visualization of the surgical area.
- Ability to operate on very small organs like ureters (about as wide as a piece of spaghetti).
This precision is particularly valuable in urological surgery, where surgeons work on small, delicate organs in difficult-to-reach areas. The enhanced accuracy allows surgeons to precisely dissect nerve bundles, better preserve erectile function, and achieve improved cancer cure rates compared to non-robotic approaches.
Minimally invasive approach: Robotic urologic procedures typically require only button-hole-sized incisions, resulting in:
- Lower risk of infection and complications.
- Reduced blood loss during surgery.
- Less trauma to surrounding tissues.
- Minimal scarring after healing.
- Decreased pain and swelling during recovery.
Improved patient recovery: Patients undergoing robotic urologic surgery experience:
- Shorter hospital stays, with many procedures performed on an outpatient basis.
- Faster recovery times compared to traditional open surgery.
- Reduced need for pain medication during recovery.
- Quicker return to normal activities.
Specific urologic applications: Robotic technology has proven particularly beneficial for numerous urologic procedures:
- Prostatectomy for prostate cancer treatment.
- Nephrectomy for kidney tumor removal.
- Cystectomy for bladder conditions.
- Kidney cyst removal.
- Pyeloplasty and ureteral reconstruction.
Surgeon benefits: The robotic system also provides advantages to surgeons that indirectly benefit patients:
- Reduced physical demands and surgeon fatigue.
- Increased comfort during procedures, allowing for better concentration.
- Ability to perform complex procedures that would be difficult or impossible with other techniques.
The adoption of robotic surgery for urologic procedures has grown significantly. This widespread use is due to this technology’s substantial benefits to patients and surgeons.
Sources
Editor’s Pick: Robotic Surgery and Its Application in Urology: A Journey Through Time
https://www.emjreviews.com/urology/article/editors-pick-robotic-surgery-and-its-application-in-urology-a-journey-through-time-j180121
Single Port Robotic Kidney Autotransplantation: Initial Case Series and Description of Technique
https://www.goldjournal.net/article/S0090-4295(23)00198-X/abstract
Experimental and clinical transplantation
https://ectrx.org/forms/ectrxcontentshow.php?doi_id=10.6002/ect.2014.0238
