Robotic urological surgery

Urologists have been at the forefront of the development and use of robotic technology. The first robot-assisted laparoscopic prostatectomy was performed in 2000. The FDA approved the da Vinci Robotic Surgical System in 2000. Its use has increased dramatically over the years, notably among urologists. Current residents and recently graduated urologists are almost universally exposed to robotic surgery. The field of robotics is ever changing. Advances are being made in the fields of telementoring and telerobotics as well as design changes making robotic surgery in combination with imaging such as MRI or CT more feasible. The field of urology has been quick to embrace technology and robotic surgical assistance, utilizing this technology for oncologic, urogynecologic, reconstructive, and pediatric urological cases. Assistance during these operations is critical. Bedside assistants help with retraction, suction of the surgical field, placement of clips, passage of suture, use of a stapler, manipulation of the Foley catheter, removal of surgical specimen, etc. Clear communication between surgeon and assistant and surgeon and anesthesiologist is crucial for patient safety, operative technique, and patient outcomes. Prostatectomy – Radical and Simple In 2015, 220,800 men were diagnosed with prostate cancer, and 27,540 men died of the disease. Over 2.7 million men are living with prostate cancer in the United States currently (Howlader et al., n.d.). Overall, it is one of the most common conditions treated by urologists and is the most common urologic malignancy. In 2011, more than 80% of radical prostatectomies were performed with the assistance of a robot. While the cost of the robotic approach leads to criticisms, there are clear benefits (Skolarus et al., 2010). Further studies are ongoing, but with the widespread dissemination of robots into hospitals and ever-increasing number of urologists trained on the robot, robotic-assisted laparoscopic prostatectomies will likely remain the surgery of choice for prostate cancer treatment. Radical Prostatectomy This operation involves removal of the entire prostate gland and seminal vesicles, with reconnection of the urethra directly to the bladder to restore continuity of the genitourinary tract. This is typically done for prostate cancer. It is one of the most common procedures utilizing robotic assistance, across all specialties. The original radical prostatectomy was performed in 1905 via a perineal approach, which was then modified to the lower abdominal extraperitoneal approach (McDougal et al., 2011).