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Robot-Assisted Urologic Procedures

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by McCoy K
 

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, which is a 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 such as 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
 

What to Expect

Prior to Procedure

Depending on the reason for your surgery, your doctor may do the following:
Leading up to the procedure:
  • Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
  • 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 internal structures to be viewed. A small camera, called an endoscope will be passed 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
Surgical Tool
Copyright © Nucleus Medical Media, Inc.
While sitting at a console near the operating table, the doctor will use lenses to look at a magnified 3D image of the inside of the body. Another doctor will stay by the table to adjust the camera and tools. The robotic arms and tools will be guided with joystick-like controls and foot pedals. After the tools are removed, sutures or staples will be used to close the surgical area.

How Long Will It Take?

About 2-4 hours, depending on the procedure

Will It Hurt?

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications. You may also feel discomfort from the gas used during the procedure. This can last up to 3 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.
  • While resting, keep your legs elevated. Move your legs to avoid blood clots.
  • Wash the incisions with mild soap and 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.
  • Limit certain activities, such as driving, working, and doing strenuous exercise, until you have recovered.
Total recovery usually takes about 3-6 weeks.
 

RESOURCES

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

Urology Care Foundation
http://www.urologyhealth.org

 

CANADIAN RESOURCES

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

The Kidney Foundation of Canada
http://www.kidney.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 25, 2013.


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.


Megaureter. Children’s Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site1288/mainpageS1288P0.html. Accessed July 25, 2013.


Minimally invasive procedures. Emory Healthcare website. Available at: http://www.emoryhealthcare.org/urology/treatment-services/minimally-invasive.html. Accessed July 25, 2013.


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 25, 2013.


Robotic dismembered pyeloplasty. Cleveland Clinic website. Available at: http://my.clevelandclinic.org/services/robotic%5Fdismembered%5Fpyeloplasty/urology%5Foverview.aspx. Accessed July 25, 2013.


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

 

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