Advanced Robotic Partial Nephrectomy at Fortis Hospital Bangalore

Over the past few years, robotic technology has increasingly grown in popularity and its usage has increased by leaps and bounds in surgical care across the world. As a matter of fact, the da Vinci robotic system has become the go-to robotic system for general laparoscopic surgery which is evident by the fact that nearly 5,000 robotic surgical systems are currently in use all around the world.

Some of the many benefits of robotic surgery are:

• Precision as it allows for surgery to be carried out in the tightest of spaces
• Allows surgeons to have a better hand to eye coordination
• Drastically decreases the chances of the surgeon experiencing tiredness or fatigue at the end of the day thereby helping reduce human error as well.
• Ergonomic design appeals to the surgeon thus making surgeries physically less demanding vis-à-vis open surgery
• Enables 3D natural vision and enhanced depth perception
• Has resulted in a marked improvement in the quality of patient care as compared to alternative surgical approaches.
• Patients can recover very quickly from all sorts of difficult/complex surgeries

The main disadvantage of robotic surgery can be attributed to the increased cost along with the loss of tactile/haptic sensation.

What is Urological surgery?

Surgeries pertaining to diseases affecting the male/female urinary tract as well as the male reproductive tract can be termed as Urological surgery. Thereon, the organs which are primarily covered are the kidneys, urethra, ureters, adrenal glands, urinary bladder as well as the male reproductive system including the penis, testes, prostate, vas deferens, seminal vesicles, epididymis).

Since the last decade, there has been an increased buzz in the field of urological surgery and it has been applied to two specific areas, in particular, i.e. Endourology and Laparoscopy. Robotic surgery can be applied to the following procedures in the field of urology:

• Partial nephrectomy
• Radical nephrectomy
• Radical prostatectomy
• Radical nephroureterectomy
• Adrenalectomy
• Cystectomy
• Kidney transplantation
• Vesicovaginal fistula repair
• Reconstructive renal &  ureteral surgeries- ureteric re-implantation etc.
• Pyeloplasty for ureteropelvic junction obstruction (UPJO)
• Retroperitoneal lymph node dissection
• Inguinal lymph nodes dissection
• Urinary diversion
• Sacrospinous suspension

What is a robotic partial nephrectomy ?

Also known as nephron-sparing surgery, partial nephrectomy can be better described as the partial removal of a tumour from the kidney tumour while leaving the healthy kidney behind. This kind of surgery is usually opted for when the size of the tumour is less than 4cm. Thus instead of taking out the entire kidney and by focusing on only removing the cancerous lesion, the remaining renal function can be maximized. This, in turn, has been revealed to have significantly improved kidney cancer outcomes by allowing to treat more complex cancers thus notably decreasing the rates of any cardiovascular complications in the future.

In case of a robotic partial nephrectomy, more often than not, the da Vinci Robotic Prostatectomy is the way forward. Accordingly, a combination of high-definition 3D magnification, state-of-the-art robotic technology as well as a bunch of miniature instruments is used in order to remove the tumour. Besides, this minimally invasive technique is also said to drastically enhance the urologic surgeon’s skills when removing the cancerous portion of the kidney and reconstructing the remaining healthy kidney. The ultimate goal is allowing patients to experience high-quality surgical treatment but with the aid of small incisions so that the patients are able to quickly recover and get back to their lives as soon as possible post-surgery.

The Surgical Procedure

A robotic partial nephrectomy requires that the patient gets administered with general anaesthesia. The average operating time is approximately 3-4 hours. That said, operative time tends to vary from individual to individual. Robotic partial nephrectomy makes use of slender telescope-like instruments (robotic arms) and a camera which is placed through approximately 3 to 5 small keyhole (< 1cm) incisions as opposed to a large 6 to 8-inch long incision that is typically required in a traditional open partial nephrectomy. The surgeon remotely controls the robot with the aid of a console located at a short distance away from the patient where the magnified operating field can be viewed in 3-D.

There are four available arms – which basically acts as an extension of the surgeon’s hands. The first arm has a 3-D camera attached to it and gives the surgeon enhanced detail along with a true depth of field and a panoramic view thus allowing him/her to accomplish the surgery with improved visualization and mechanical precision. Also, the robotic hands’ wide range of movement enables the surgeons to wield greater dexterity.

Besides reducing the incidence of pain and minimizing the risk of infection, patients are said to also experience decreased blood loss, less scarring as well as quicker recovery time. Moreover, the effectiveness of the robotic approach has been revealed to be equal to that of the traditional approach with significantly less morbidity

However, this approach is not recommended in case of patients who are diagnosed with large tumours (more than 4 cm) or in case of tumours which have been shown to invade nearby structures (e.g. vena cava, liver, or bowel). These type of patients may be best suited to opt for an open or traditional approach owing to the extent and need for adjacent organ resection. In addition, patients suffering from medical conditions such as severe lung and heart disease may not be suited to a robotic approach.