Robotic-Assisted Surgery Gaining Wider Use in Treating Urinary System Cancers
 

The urinary system consists of many organs that work together to produce and eliminate urine from the body. The main organs involved in this process are the kidneys, ureter, bladder, urethra, and, in males, the prostate gland, an organ located under the bladder.
 
The most common disorders of the urinary system, such as urinary tract infections, kidney, ureter and bladder stones, chronic kidney disease, and urinary tract cancers — particularly kidney cancer and prostate cancer — are often associated with these organs.
 

Kidney and Prostate Cancer Surgeries

Kidney cancer is one of the urologic diseases that has benefited most from the use of robotic-assisted surgery. This is because surgery is considered the primary treatment while cancer cells are still confined to the kidneys, as well as the fact that the kidneys are located in the upper retroperitoneal space, towards the back muscles, making them difficult to access. Kidney cancer surgeries require the surgeon to exercise extreme precision and accuracy while performing surgery on the kidneys.
 
As for robotic-assisted prostate cancer surgery, this method has been widely accepted by surgeons around the world for over 20 years. In this case too, surgery is considered to be fairly complicated as the prostate gland is also a difficult-to-reach organ, presenting obstacles for traditional surgery in terms of the need to preserve the surrounding nerves, blood vessels and muscles needed for maintaining control of urination and erectile function.
 
Robotic assistance aids the surgeon in performing the most demanding aspects of the procedure, as the robotic instrumentation can move more freely and more easily access narrow spaces or deep locations than would be possible with human hands. This results in greater precision of surgical cuts involving the prostate, sphincter and nerves, providing patients with greater post-surgery control of urination and sexual performance.
 

The Surgical Procedure

Once anesthesia and intubation have been carried out by the anesthesiologist, the patient is placed on their side. The robotic arms at the patient’s bedside are used to insert the tiny camera and surgical instruments through four small incisions in the abdominal wall area. During surgery, the abdomen is inflated with carbon dioxide to create more space and to enable the surgeon to view the inside of the body more clearly.  
      
During robotic-assisted surgery, the surgeon sits at a console in the operating room and performs the surgery while the computer transmits real-time signals from the motions of the surgeon’s hands, wrists and fingers to surgical instruments attached to the robotic arms that carry out the surgery on the patient. The high-definition magnification camera provides the surgeon with real-time 3D images of the patient’s internal organs, tissues and nerves, thus resulting in depth perception not available in conventional endoscopic surgeries.
 

Kidney Surgery’s Unique Challenges

For kidney cancer, surgical removal of malignant tumors and suturing of the remaining kidney tissue must be carried out for a period when there is no blood flow to the kidney. To accomplish this, the surgeon must use a clamp device to temporarily stop kidney blood flow. In order to preserve the kidneys, however, this interruption in blood flow should last no longer than 25 to 30 minutes.
 
A partial nephrectomy — the surgical removal of a portion of the kidney — is a race against time, and both the surgery and the suturing must be precise and highly efficient. After surgery, the doctor will place drainage tubes through the abdominal incisions to drain fluids, urine, and some blood from the area. These will be removed two or three days after surgery, and the surgeon will check for any urinary leakage from the surgical wounds. The partial nephrectomy procedure typically takes about three hours.
       

Robotic-assisted Prostatectomy Surgery

During prostate cancer surgery (prostatectomy), the surgeon removes the prostate gland and surrounding tissues, including the vas deferens, the seminal vesicles, and some lymph nodes. From there, the bladder is sewn back to the urethra to restore continuity of the urinary tract.
 
After surgery, drainage tubes will be placed through the incisions in the abdominal wall to check for urine leakage from the surgical site. These tubes will remain in place for about three or four days. A urinary catheter will also be in place for about seven days to drain urine from the body. Prostatectomy surgery typically takes two to three hours.
 

Robotic-assisted Benefits

The use of robotic-assisted surgery has become increasingly common for treating patients with urinary system cancers, thanks in part to the increased dexterity it offers surgeons versus traditional open and laparoscopic surgeries, along with the enhanced 3-dimensional views provided in real time by the high-resolution camera. These advantages can be particularly compelling when surgery involves the prostate or kidneys, where precision and maneuverability are critical to success.
 
 
 
By Dr Teerapon Amornvesukit, a urologist specializing in Laparoscopic and 
Robotic Urologic Surgery at Bumrungrad International Hospital