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Robot-Assisted Urologic Procedures

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Definition

A doctor guides robotic arms to do urologic surgery. This is done through several tiny keyhole incisions.

Male Genital and Urinary Systems
Male Genito-urinary System
From top to bottom: Kidneys, ureters, bladder, prostate, and urethra.
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Reasons for Procedure

Examples of urologic surgeries that have been successfully done using this technique include:

  • Prostatectomy —to remove part or all of a prostate gland found to contain prostate cancer
  • Pyeloplasty —to repair an abnormality of the kidney and nearby ureter, which is a tube that leads from the kidney to the bladder
  • Cystectomy —to remove all or part of the bladder to treat bladder cancer
  • Nephrectomy —to remove all or part of the kidney because of kidney cancer, kidney stones, or kidney disease
  • Ureteral reimplantation—to disconnect and reinsert the ureter from the bladder to keep urine from flowing backwards from the bladder into the kidneys
  • Procedures requiring fine dissection and suturing such as reconnection of the ureter

Compared to more traditional procedures, robotic-assisted surgery may result in:

  • Less scarring
  • Reduced recovery times
  • Less risk of infection
  • Less blood loss
  • Reduced trauma to the body
  • Shorter hospital stay
  • Faster recovery

Possible Complications

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Damage to nearby organs or structures
  • Infection
  • Bleeding
  • Anesthesia-related problems
  • The need to switch to traditional surgical methods such as traditional laparoscopic or open surgery

Some factors that may increase the risk of complications include:

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:

Leading up to the procedure:

  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • Take antibiotics if instructed.
  • Follow a special diet if instructed.
  • Shower the night before using antibacterial soap if instructed.
  • Arrange for someone to drive you home from the hospital. Also, have someone to help you at home.
  • Eat a light meal the night before. Do not eat or drink anything after midnight.

Anesthesia

General anesthesia will be used. It will block any pain and keep you asleep through the surgery.

Description of the Procedure

Several small keyhole incisions will be made in the abdomen. Carbon dioxide gas will be passed into the area. This will make it easier for internal structures to be viewed. A small camera, called an endoscope will be passed through one of the incisions. The camera will light, magnify, and project the structures onto a video screen. The camera will be attached to one of the robotic arms. The other arms will hold instruments for grasping, cutting, dissecting, and suturing; for example:

  • Forceps
  • Scissors
  • Dissectors
  • Scalpels
Instrument Used in Procedure
Surgical Tool
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While sitting at a console near the operating table, the doctor will use lenses to look at a magnified 3D image of the inside of the body. Another doctor will stay by the table to adjust the camera and tools. The robotic arms and tools will be guided with joystick-like controls and foot pedals. After the tools are removed, sutures or staples will be used to close the surgical area.

How Long Will It Take?

About 2-4 hours, depending on the procedure

Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications. You may also feel discomfort from the gas used during the procedure. This can last up to 3 days.

Average Hospital Stay

About 1-2 days, depending on the procedure

Post-procedure Care

When you return home, do the following to help ensure a smooth recovery:

  • For some procedures, a urine catheter will be left in place for a while. You will be instructed on how to care for this.
  • While resting, keep your legs elevated. Move your legs to avoid blood clots.
  • Wash the incisions with mild soap and water.
  • Drink plenty of fluids. This will help to clear your bladder.
  • Avoid constipation . Eat a high fiber diet. Drink plenty of water. Use stool softeners if necessary.
  • Avoid caffeinated beverages, alcohol, spicy foods, or other food or drink that might upset your stomach, intestines, or urinary tract.
  • Limit certain activities, such as driving, working, and doing strenuous exercise, until you have recovered.

Total recovery usually takes about 3-6 weeks.

Call Your Doctor

It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:

  • Catheter stops draining or falls out—if you had a catheter placed
  • Difficulty urinating
  • Heavy bleeding or clots in the urine
  • Pain, burning, urgency, or increased frequency of urination
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
  • Abdominal swelling or pain
  • Constipation, nausea, vomiting, or diarrhea
  • Pain and/or swelling in your feet, calves, or legs
  • New or worsening symptoms

If you think you have an emergency, call for medical help right away.

Revision Information

  • National Kidney and Urologic Diseases Information Clearinghouse

    http://kidney.niddk.nih.gov

  • Urology Care Foundation

    http://www.urologyhealth.org

  • Canadian Urological Association

    http://www.cua.org

  • The Kidney Foundation of Canada

    http://www.kidney.ca

  • Bladder cancer—robot-assisted laparoscopic radical or simple cystectomy. University of Chicago website. Available at: http://www.ucurology.org/procedures/laparoscopic-surgery/%5F%5Fbladder-cancer--robot-assisted-laparoscopic-radical-or-simple-cystectomy. Accessed July 25, 2013.

  • Carmack AJ, Siddiq FM, Leveillee RJ. Novel use of da Vinci Robotic Surgical System: removal of seminal vesicle cyst in previously dissected pelvis. Urology. 2006;67(1):199.

  • Megaureter. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site1288/mainpageS1288P0.html. Accessed July 25, 2013.

  • Minimally invasive procedures. Emory Healthcare website. Available at: http://www.emoryhealthcare.org/urology/treatment-services/minimally-invasive.html. Accessed July 25, 2013.

  • Passerotti CC, Diamond DA, Borer JG, Eisner BH, Barrisford G, Nguyen HT. Robot-assisted laparoscopic ureteroureterostomy: description of technique. J Endourol. 2008;22:581-584.

  • Robot-assisted laparoscopic radical prostatectomy. Johns Hopkins Medicine website. Available at: http://urology.jhu.edu/MIS/roboticRRP.php. Accessed July 25, 2013.

  • Robotic dismembered pyeloplasty. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/robotic%5Fdismembered%5Fpyeloplasty/urology%5Foverview.aspx. Accessed July 25, 2013.

  • Takacs EB, Kobashi KC. Minimally invasive treatment of stress urinary incontinence and vaginal prolapse. Urologic Clinics of North America. 2008;35(3):467-476.