Know All About the New Robotic Surgical Systems in Urology!

What Is Urology?

Urology is a branch of medicine that deals with studying conditions affecting the male and female urogenital tract. Urology addresses urinary tract problems and the reproductive organs like the testes, ovaries, penis, scrotum, and prostate. Doctors who specialize in the field of urology are known as urologists. They are trained to diagnose, detect, and treat the conditions affecting the kidneys, bladder, ureters, and urethra. In males, a urologist might also resolve the testis, scrotum, and penis problems. In contrast, the urologist addresses the problems of the vagina, cervix, and other reproductive organs in females. Sometimes, the urologist might need to work with a radiotherapist and an oncologist to treat urinary cancer.

What Is a Urinary Tract?

The human body comprises nine major organ systems that work as a team to carry out the body's essential functions and keep it healthy. The urinary system is one of them and consists of several organs that work to remove waste from the body. In addition to the urinary system, other organs within the body helps get rid of the waste. The urinary tract organs are connected with the help of tubes and are further connected to the digestive system and the blood vessels. The body derives energy from food to carry out daily activities. After the body has used the food products, unused ones are left as waste in the blood and the bowel. The urinary system filters blood, and the waste products are separated and converted to urine.

What Is a Robotic Surgical System in Urology?

Robot-assisted surgical procedures have become a leading-edge technology because they are minimally invasive. Their accuracy and precision make them ideal for complex and delicate urologic surgeries. For example, the target organ in prostatectomy is the prostate gland, but various nerves and blood vessels surround it. If open surgery is done, the risk of nerve damage increases. However, the robotic system consists of instruments that help operate the exact site without damaging the surrounding organs.

What Are the Benefits of Robot-Assisted Surgical Systems in Urology?

Robot-assisted surgical procedures are beneficial not only for adults but also for children. They can easily treat common urinary tract disorders like ureteropelvic junction obstruction and kidney infections. The benefits of robot-assisted surgical procedures are listed below:

1. It is less painful.

2. Blood loss is less.

3. Minimal risk of infection.

4. Fewer chances of scarring.

5. The patient need not stay in the hospital for too long.

6. The recovery rate is high.

7. Excellent clinical outcomes.

What Are Some of the Disadvantages of Robotic Surgery?

Every coin has two sides, and the same goes for robotic surgery. It has certain advantages and disadvantages. The disadvantages of robotic surgery are listed below:

• The surgery is expensive, so most patients find it difficult to afford.

• The surgery can only be done by a doctor who has received a lot of training.

• Sometimes, the doctor might need to switch to an open or laparoscopic approach because of the complications associated with this surgery.

• Robotic surgery is usually time-consuming compared to open or laparoscopic surgery.

What Are the New Robotic Surgical Systems in Urology?

Robotic assistance in urologic surgery was introduced recently, which marked a milestone in the history of urology. Urologists are adopting this new robotic surgery system, and the da Vinci surgical system has dominated the robotic surgery market for the last 20 years. Robot-assisted surgeries have helped doctors overcome the limitations of minimally invasive surgery and laparoscopic surgery. The currently approved robotic surgical systems in urology are listed below:

• Da Vinci Surgical System - The da Vinci surgical system was approved in the 2000s and has remained the robotic system of choice for 20 years. This system gives the surgeon an advanced set of instruments to perform minimally invasive robotic surgery. The patient need not worry because the robot does not perform the surgery. The surgeon performs the surgery by using the instruments that he guides through a console. The da Vinci system translates the surgeon’s hand moments at the console to real-time moments, and the instruments move like a human hand to perform the procedure.

• Senhance System - The Senhance system was developed by an Italian company and received the certification to perform abdominal and urologic procedures. This system consists of four independent robotic arms, and the surgeon sits in an open console similar to a cockpit. The monitor attached to the cockpit provides three-dimensional images of the operating site. An infrared eye-tracking system controls the camera movements through a surgeon’s eyes. The handles present at the end of the Senhance robotic system consist of instruments to carry out the surgical procedure.

• Revo I - The Revo I robotic surgical system received approval from the Korean Ministry of Food and Drug Safety in 2017. It consists of a four-arm patient cart, a surgeon console, and a vision cart. The surgical instruments are reusable and provide seven degrees of freedom. The Revo I surgical system is commonly used in cholecystectomy, partial nephrectomy, and fallopian tube reconstruction surgeries.

• Versius - The Versius robotic surgical system received European certification in March 2019. It consists of a robotic arm with a shoulder, a wrist joint, and an elbow. This robotic arm mimics the movements of a human arm. It consists of a console that requires polarized glasses for vision. The surgeon can operate in the sitting or standing position by controlling the system through the joystick handles. The surgical instruments provide seven degrees of freedom and effectively carry out prostate, renal, pelvic, and gynecologic surgeries.

• Avatera - The Avatera system was recently launched and is used to carry out minimally invasive procedures related to urologic and gynecologic and urologic surgeries. The Avatera system consists of a surgical robot and a console. The surgeon sits at the console and guides the robot to perform the surgery.

• Hinotori - The Hinotori is the made-in-Japan robotic surgical system that received approval from the Japanese Ministry of Health, Labor, and Welfare. The Hinotori robotic system consists of the operative unit, the surgeon’s cockpit, and the vision unit. The operative units consist of four robotic arms that can move in eight axes. The surgeon mainly controls the instruments attached to the robotic arm.

What Are the Differences Between Robotic Surgery and Other Surgeries?

There are three ways by which surgery can be carried out in urology: open surgery, laparoscopic surgery, and robotic surgery. The doctor cuts in open surgery and operates manually. In laparoscopic surgery, the surgeon inserts a telescope-like instrument into the body to visualize the urinary tract. On the contrary, in robotic surgery, the surgeon controls the robot and the movement of the surgical instruments. The following points compare robotic surgery with other surgeries:

• The patient experiences less surgical trauma in robotic surgery than in open surgery because it is minimally invasive.

• The robotic arms have a wide range of motion, the biggest limitation of open and laparoscopic surgeries.

• Robotic surgery allows the doctor to visualize and operate on areas beyond the reach of open or laparoscopic surgery.

• Robotic surgery provides a high-resolution and three-dimensional view of the operating site, which is impossible with open or laparoscopic surgery.

• The accuracy and precision of robotic surgery are way better than open or laparoscopic surgery.

• Robotic surgery is less tiring as the surgeon sits behind the console and performs the surgery.

Conclusion:

Robotic surgery has opened new avenues for learning, mentoring, and training in urology. If a surgeon is well trained, he can easily perform robotic surgery and save time. Earlier, open and laparoscopic surgeries were the only means of addressing urinary tract problems. However, the scenario has changed because of the advancements in medical science. Robotic surgery has emerged as the new method of solving urinary tract problems. Some robotic systems are being used daily, while some are still under research. The type of surgery required in a patient depends on the condition and its severity. Sometimes, the doctor might switch to a laparoscopic or open surgical approach if a large incision is made and the problem is severe. So, the patient can consult a urologist to learn about urinary tract problems and the success of robotic surgical systems.