Robot-Assisted Urologic Procedures
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Robot-Assisted Urologic Procedures

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Overview ; Urologic Procedures; Laparoscopic Procedures ; Cardiac Procedures ; Thoracic Procedures

Definition

A surgeon guides robotic arms to perform a urologic procedure through several tiny “keyhole incisions.” Urologic procedures that have been successfully performed using robotic surgery include:

  • Prostatectomy—surgical removal of part or all of an enlarged prostate gland found to contain prostate cancer
  • Pyeloplasty—surgery to repair abnormality of kidney and/or nearby ureter (tube that leads from the kidney to the bladder)
  • Cystectomy—surgical removal of all or part of the bladder performed to treat cancer of the bladder
  • Nephrectomy—surgical removal of all or part of the kidney because of kidney cancer, kidney stones, or kidney disease
  • Ureteral reimplantation—surgery to disconnect the ureter from the bladder, remove a blockage that is causing urine to back up from the bladder into the ureters and kidneys, and re-implant the ureter back into its original position

Male Genital and Urinary Systems

Male Genito-urinary System

From top to bottom: Kidneys, ureter (tube), bladder, prostate, and urethra (the second tube).

© 2008 Nucleus Medical Art, Inc.

Parts of the Body Involved

  • Prostate gland
  • Bladder
  • Rectum
  • Urethra
  • Ureters
  • Kidneys
  • Uterus
  • Vagina

Reasons for Procedure

Robot-assisted urologic procedures are performed to treat a variety of conditions, including:

Risk Factors for Complications During the Procedure

A risk factor is something that increases your chances of having complications during your procedure. Risk factors for complications during robot-assisted urologic procedures include:

  • Pre-existing lung, heart or kidney disease
  • Obesity
  • Excessive alcohol intake
  • Smoking
  • Use of certain prescription medications
  • Diabetes
  • Advanced age

What to Expect

Prior to Procedure

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

  • Physical exam
  • Blood tests
  • Urine tests
  • Electrocardiogram (ECG, EKG)—a test that records the electrical currents passing through the heart muscle
  • Intravenous pyelogram (IVP)—a type of x-ray that creates images of the kidney, ureters and bladder by injecting dye into the bloodstream
  • Retrograde uretogram—a type of x-ray that create images of the bladder, ureters and kidneys by injecting dye into the bladder
  • Kidneys, ureter, bladder (KUB)—an x-ray of the abdomen
  • Ultrasound—a test that uses sound waves to visualize the inside of the body
  • CT scan—a type of x-ray that uses a computer to create images of structures inside the chest
  • MRI scan—a test that uses powerful magnets and radiowaves to create images of structures inside of the chest
  • Cystoscopy—a lighted tube equipped with a camera used to visualize the inside of the urethra and bladder
  • Review your medications with the surgeon; you may need to stop taking some of them
  • Follow a special diet, if recommended by your surgeon
  • Take antibiotics, if prescribed by your doctor
  • Shower the night before your procedure using antibacterial soap, if your doctor asks you to
  • Arrange to have someone drive you to and from the procedure, and for help at home after your procedure
  • Eat a light meal the night before , and do not eat or drink anything after midnight unless told otherwise by your doctor
  • Plan to wear comfortable clothing on the day of your procedure

Anesthesia

General or local anesthesia with sedation will be given, depending on the procedure.

Description of the Procedure

The surgeon cuts several small (approximately one-centimeter) “keyhole” incisions in the abdomen. A needle may be inserted through one of these openings to inject carbon dioxide gas into the abdomen, making it easier for the surgeon to see internal structures.

The surgeon passes a small camera (endoscope) through one of the incisions, which lights, magnifies, and projects an image of internal organs onto a video screen for the surgeon to view. The endoscope is attached to one of three or four of the surgical system’s robotic arms.

The other two or three arms hold other instruments such as dissectors, scissors, scalpels, and/or forceps. These instruments are able to grasp, cut, dissect, and suture structures inside the abdomen during the operation.

Instrument Used in Procedure

Surgical Tool

© 2008 Nucleus Medical Art, Inc.

While sitting at a console several feet away from the operating table, the surgeon looks through lenses at a magnified, three-dimensional image of the inside of the abdomen. Another surgeon stays by the patient during the procedure, where he or she can adjust the camera and instruments as needed.

With joystick-like hand controls and foot pedals, the surgeon at the console guides the movement of the robotic arms and surgical instruments. The robotic arms are able to perform surgical tasks with an increased range of motion than would be possible using traditional surgical techniques. In addition, the robotic arms can filter out hand tremor and translate the surgeon’s larger hand movements into smaller ones.

After the endoscope and other instruments are removed, the surgeon closes the incisions with sutures or staples, and applies a sterile dressing.

After the Procedure

Depending on the reason for the procedure, some of the tissue that was removed may be sent to a pathologist for examination (eg, in the case of prostate, bladder, or kidney cancer).

How Long Will It Take?

Usually 2-4 hours, but this depends on the type of procedure being done.

Will It Hurt?

General anesthesia prevents pain during surgery. Patients typically experience pain and soreness during recovery, but receive pain medication to relieve the discomfort. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days.

Possible Complications

  • Urinary incontinence—inability to control urinary stream
  • Erectile dysfunction
  • Retrograde ejaculation—sperm ejaculates into your bladder, rather than out through the urethra; this may cause urine to appear milky white after ejaculation
  • Infertility
  • Urethral stricture—abnormal narrowing of the urethra
  • Damage to neighboring organs or structures
  • Infection
  • Bleeding
  • Anesthesia-related problems
  • Sometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods (eg, traditional laparoscopic or open surgery)

Average Hospital Stay

Usually 1-2 days, but may be longer, depending on the procedure.

Postoperative Care

You will receive instructions on when and what you can eat, and how you need to restrict your activity. Your doctor will likely advise you to:

  • Take antibiotics to help prevent infection
  • Avoid certain medications
  • Drink plenty of fluids to clear your bladder
  • Eat a high-fiber diet, drink plenty of water, and use stool softeners if necessary to avoid constipation
  • Avoid caffeinated beverages, alcohol, spicy foods, or other food or drink that might upset your stomach, intestines, or urinary tract
  • Keep legs elevated and moving to avoid blood clots
  • Resume normal activities (eg, taking daily walks) soon, to promote healing
  • Limit certain activities, such as driving, walking up stairs, lifting, working, and engaging in sexual intercourse, for a period of time
  • Avoid tub baths during the first two weeks after surgery
  • Wash the incisions with mild soap and water

Outcome

Depending on your procedure, you should be able to resume most regular activities within 3-6 weeks after your procedure. Based on evidence available to date, the risks of robotic surgery appear to be less than for more traditional forms of surgery.

Benefits of robot-assisted urologic procedures over traditional ones may include:

  • Reduced trauma to the body
  • Reduced risk of blood transfusion
  • Shorter hospital stay
  • Faster recovery

Call Your Doctor If Any of the Following Occurs

It is essential for you to carefully monitor your own recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. Promptly notify your doctor if any of the following occur:

  • Catheter stops draining or falls out (if you had a catheter placed)
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from an incision site
  • Abdominal swelling or pain
  • Constipation
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Difficulty urinating, such as pain, burning, urgency, or frequency
  • Heavy bleeding or clots in the urine
  • Pain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest pain
  • Nausea, vomiting, and/or diarrhea
  • Headache, muscle aches, feeling faint or dizzy
  • Other worrisome symptoms

RESOURCES:

American Urological Association
http://urologyhealth.org

National Kidney and Urologic Diseases Information Clearinghouse
http://kidney.niddk.nih.gov

CANADIAN RESOURCES:

Canadian Urological Association
http://www.cua.org

The Kidney Foundation of Canada
http://www.kidney.ab.ca

References:

Bladder cancer—robot-assisted laparoscopic radical or simple cystectomy. University of Chicago website. Available at: http://www.ucurology.org/homeThumbs/laproscopicB6.htm . Accessed July 8, 2006.

Complete Guide to Symptoms, Illness & Surgery. Putnam Publishing Group; 2000.

Megaureter. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site1288/mainpageS1288P0.html . Accessed July 8, 2006.

Minimally invasive surgery – laparoscopic surgery. Emory Healthcare website. Available at: http://www.emoryhealthcare.org/departments/urology/sub_menu/laparoscopic.html . Accessed July 8, 2006.

Robot-assisted laparoscopic radical prostatectomy. Johns Hopkins Medicine website. Available at: http://urology.jhu.edu/MIS/roboticRRP.php. Accessed July 8, 2006.

Robotic dismembered pyeloplasty. Cleveland Clinic website. Available at: http://cms.clevelandclinic.org/urology/body.cfm?id=221 . Accessed July 8, 2006.



Last reviewed April 2008 by Rosalyn Carson-DeWitt, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


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