Robotic Urologic Surgery

Introduction: What is Robotic Urologic Surgery?

Robotic urologic surgery involves the use of robotic technology to perform a variety of urologic operations to treat conditions of the urinary tract, including the kidney, ureters, bladder and prostate in males. This is a minimally invasive alternative to conventional open surgery.

Operations are performed laparoscopically, which means only small keyhole incisions need to be made. Robotic surgeries are more precise and possibly result in less tissue disruption to surrounding structures and improve outcomes in certain urological surgeries.

With keyhole incisions, better visualisation and range of motion of surgical instruments, robotic urologic surgeries confer benefits such as less blood loss, shorter hospital stays, lower chances of complications and quicker recovery.

Dr Terence Lim was the director of Changi General Hospital’s Advanced Surgical Centre, a committee dealing with complex surgeries, including robotic surgeries. He operated on all three generations of the da Vinci Robotic Surgical System and is amongst the first few urologists in Singapore to operate using the latest generation of this technology. To date, he has been involved in over 700 robotic surgeries and was the first urologist in Singapore to perform a robot-assisted Retzius-sparing Prostatectomy. In addition, he is an appointed Visiting Urology Consultant to CGH and is frequently asked to proctor his colleagues in robotic surgeries.

What conditions can Robotic Urologic Surgery treat?

Robotic surgery can be used to perform a variety of urinary procedures, such as, but not limited to:

Prostatectomy: the removal of part or all of the prostate gland. This may be done to treat conditions such as prostate cancer and very large benign prostatic hyperplasia.
Partial or Radical Nephrectomy: the removal of part of or all of the kidney. This may be done to treat kidney cancer, as well as other kidney diseases and injuries.
Pyeloplasty: the reconstruction of the renal pelvis; often done to relieve a ureteropelvic junction obstruction, resulting in blockage of urine flow.
Cyst Removal: the removal of cysts from urinary organs such as the kidney if clinically indicated.
Partial or Radical Cystectomy: the removal of part of or all of the bladder. This may be done to treat invasive bladder cancer. Robotic surgery can also be done to reconstruct the urinary tract after a radical cystectomy is performed.
Ureteral Implantation: the reimplantation of the ureters (tubes that carry urine from the kidneys to the bladder) through repositioning.

What is the difference between conventional open surgery and robotic urologic surgery?

In open surgeries, in order to access diseased organs, a large surgical incision will be made in order to have the surgeon’s hands in the body. In robotic surgery, smaller, 1 cm keyhole-sized incisions are made for the miniature robotic instruments to pass through. Much like a surgeon’s hands offering great manual dexterity, the use of robotic instruments provides a high degree of range of motion and precision.

Additionally, in robotic urologic surgery in Singapore, a high-definition, three-dimensional endoscope is used, providing the surgeon with a clear and magnified view of the vital surrounding structures. This allows the surgeon to operate at a higher degree of accuracy and entails less disruption to healthy tissue.

Achieving the best of both worlds

Dr Terence Lim views the robot as a surgical tool, and, as surgeons, they are entrusted with the responsibility of choosing the most appropriate tools for the best surgical outcomes for their patients.

Conventional open surgeries:

Benefits: confer the benefit of having the surgeon’s hands in the body, offering excellent manual dexterity in instrument and tissue handling.
Limitations: it requires a large surgical incision and provides limited vision, especially when working on deep pelvic organs.

Conventional laparoscopic procedures:

Benefits: minimally invasive and performed through keyhole-sized incisions.
Limitations: limited dexterity and two-dimensional vision.

The robotic approach can be thought of as a combination of the best of both worlds. It allows for magnified 3D visualisation of the operative field and dexterity in instrument handling, simulating the surgeon’s hands in the body, all done through keyhole-sized incisions.

What are the benefits of Robotic Urologic Surgery?

The use of robotic surgery provides the surgeon with a greater range of motion, flexibility and precision. Smaller incisions are also needed to access the site of operation.

Compared to open surgeries, robotic urologic surgery offers multiple benefits such as:

Less postoperative pain
Less blood loss
Less risk of infection
Shorter hospital stays
A speedier recovery
Less noticeable scars

Compared to conventional laparoscopic surgeries, the benefits of robotic urologic surgery include the following:

Possibly higher chances of cancer clearance, retained urinary function and sexual health in radical prostatectomy
Possibly lower rate of conversion to open surgery and to radical surgery and shorter warm ischaemia time in partial nephrectomy.

What is the success rate of Robotic Urologic Surgery?

Generally, cure rates are similar to open surgery. However, patients experience quicker recoveries.

Frequently Asked Questions

What is Robotic Surgery in Urology?

Robotic urologic surgery is a minimally invasive procedure that employs robotic technology to address and treat a number of urological conditions, including cancer. Robotic surgery can be utilised to carry out several urinary procedures, such as prostatectomy (removal of all or part of the prostate gland), nephrectomy (removal of all or part of the kidney), and cystectomy (removal of all or part of the bladder). This robotic technique can also be used to reconstruct the renal pelvis (pyeloplasty), and reimplant the ureters (ureteral implantation).

For more information, including some myths and facts about robotic surgery, feel free to browse our platform or reach out to our friendly team.

What Are the Benefits of Robotic Surgery in Urology?

With its innovative technology, robotic urologic surgery in Singapore has transformed healthcare, allowing patients to experience many benefits along with fewer complications and shorter recovery times.

Here are some of the key benefits of robotic surgery:

Safe and effective (enhanced freedom of movement to facilitate the surgery)
Less post-operative pain (minimally invasive procedure)
Smaller scars (due to keyhole-sized incisions)
Shorter hospital stays

What Are the Three Common Types of Robotic Surgeries?

The three most commonly performed robotic urologic surgeries are radical prostatectomy, partial nephrectomy, and pyeloplasty. Radical prostatectomy is a procedure performed to remove all or part of the prostate gland. This is typically carried out to treat prostate cancer. Partial nephrectomy is essentially a kidney-sparing surgery that involves removing a portion of the kidney. This procedure is beneficial in treating kidney cancers and improving the function of the kidneys.

Robotic pyeloplasty, on the other hand, is commonly used to repair ureteropelvic junction obstructions (UPJ). This minimally invasive robotic surgery is as effective as conventional open surgeries but with smaller incisions and shorter recovery periods. A robotic surgery expert like Dr Terence Lim, who has years of experience in handling robotic surgeries, will be able to perform this procedure with enhanced precision and control.

Dr Lim has operated on all three generations of the da Vinci Robotic Surgical System and has been involved in over 700 robotic surgeries! He was also the first urologist in Singapore to perform a robot-assisted Retzius-sparing Prostatectomy. Furthermore, he previously served as a Director at the Changi General Hospital’s Advanced Surgical Centre, which is a committee that deals with complex surgeries, including robotic surgery. Although he is now the Medical Director of Assure Urology & Robotic Centre, he is frequently asked to proctor his colleagues and subordinates for his robotic surgery expertise.

Is Robotic Urologic Surgery More Effective Than Laparoscopic Surgery?

With more freedom of movement and a magnified operative field, robotic surgery offers enhanced dexterity and precision. These benefits can result in enhanced outcomes for certain laparoscopic surgeries, especially complex ones that require the reconstruction of tissues or organs.

According to a systematic review of 50 studies conducted on robotic-assisted surgery, it was observed that 39 studies showed fewer complications with robotic surgery in comparison to laparoscopic surgery. In addition, as per the findings of the 2015 study conducted by Chandra et al., robotic surgery increased the success rates of partial nephrectomy by 52%.

If you would like to learn more about robotic surgery and its success rate, as well as the multitude of benefits that come with this type of surgery, do get in touch with us at Assure Urology & Robotic Centre to schedule a consultation with one of Singapore’s robotic urologic surgery experts, Dr Lim.

Summary

Proper management involves carrying out detailed investigations to help you understand your options for urological treatment, which your urologist will discuss with you. Many urological conditions can be treated through robotic urologic procedures if indicated. Overall, robotic surgery is a minimally invasive alternative to open surgery, which entails many recovery-related benefits.