Robot-Assisted Urologic Procedures

Definition

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

Male Genital and Urinary Systems

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

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 (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 (eg, 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

Complications are rare, but no procedure is completely free of risk. If you are planning to have a robot-assisted urologic procedure, your doctor will review a list of possible complications, which may include:

Damage to neighboring organs or structures
Infection
Bleeding
Anesthesia-related problems
The need to switch to traditional surgical methods (eg, traditional laparoscopic or open surgery)

Some factors that may increase the risk of complications include:

Pre-existing heart or lung condition
Advanced age
Diabetes
Obesity
Smoking
Excessive alcohol intake
Use of certain medicines

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:

Physical exam
Blood tests and 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 contrast into the bloodstream
Retrograde pyelogram—a type of x-ray that creates images of the ureters and kidneys by injecting contrast into the ureter through 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 body
MRI scan —a test that uses powerful magnets and radiowaves to create images of structures inside the body
Cystoscopy —a lighted tube equipped with a camera used to visualize the inside of the urethra and bladder

Leading up to the procedure:

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs (eg, aspirin )
- Blood thinners such as clopidogrel (Plavix) or warfarin (Coumadin)
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 the doctor to see the internal structures. The doctor will then pass a small camera, called an endoscope, 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

While sitting at a console near the operating table, the doctor will look through lenses at a magnified 3D image of the inside of the body. Another doctor will stay by the table to adjust the camera and tools. With joystick-like controls and foot pedals, the doctor will do the surgery by guiding the robotic arms and tools. After the tools are removed, the doctor will use sutures or staples to close the surgical area.

How Long Will It Take?

About 2-4 hours (depending on the procedure)

Will It Hurt?

You will have pain and discomfort during recovery. Your doctor will give you pain medicine. 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.

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.
If advised by your doctor, take antibiotics. You will need to avoid other medicines. Talk to your doctor about which ones.
While resting, keep your legs elevated. Move your legs to avoid blood clots.
Avoid taking a bath during the first two weeks after surgery.
Wash the incisions with mild soap and water.
Ask your doctor about when it is safe to shower, bathe, or soak in 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.
Resume normal activities (eg, daily walks) soon. This will promote healing.
Limit certain activities (eg, driving, working, doing strenuous exercise) until you have recovered.
Be sure to follow your doctor's instructions.

Total recovery usually takes about 3-6 weeks.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:

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
Cough, shortness of breath, or chest pain
Pain and/or swelling in your feet, calves, or legs
Other worrisome symptoms

In case of an emergency, call for medical help right away.

RESOURCES

American Urological Association http://www.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/procedures/laparoscopic-surgery/%5F%5Fbladder-cancer--robot-assisted-laparoscopic-radical-or-simple-cystectomy. Accessed July 8, 2006.

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.

Griffith HW. Complete Guide to Symptoms, Illness & Surgery. New York, NY: 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/urology/treatment-services/minimally-invasive.html. Accessed July 8, 2006.

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 8, 2006.

Robotic dismembered pyeloplasty. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/robotic%5Fdismembered%5Fpyeloplasty/urology%5Foverview.aspx. Accessed July 8, 2006.

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

Revision Information

Reviewer: Marcin Chwistek, MD
Review Date: 11/2012 -
Update Date: 11/30/2012 -

Cartersville Medical Center