Robot operations: 5 types of surgical operations in details (with steps and benefits)

Urology is a complex field that involves many types of robot operations. In many of our articles we’ve talked about bout the importance of the innovations that the robotic surgery has brought to urology, even on the patients’ side.

Now let’s take a deep dive into robot operations. We’ll analyze 5 different types of surgical operations that nowadays can be performed with the help of a robotic system.

The types of robot operations

There’s a variety of conditions that are treated with urological operations, specifically those affecting the prostate, the bladder and the kidney (including cancer).

The most used robotic procedures in urology are:

Prostatectomy (the removal of the prostate).
Cystectomy (removal of the bladder or just parts of it).
Nephrectomy (removal of a kidney or just parts of it).
Ureteroplasty (removal or reconstruction of part of the urinary tract).
Retroperitoneal Lymph Node Dissection or RPLND (removal of the lymph nodes at the back of the abdomen).

Robotic prostatectomy

Robotic prostatectomy is a surgical procedure performed to treat prostate cancer. It consists in the removal of the prostate gland, the seminal vesicles, and sometimes the nearby lymph nodes. Nowadays this type of robot operation is performed with the Da Vinci Surgical System. A correct prostatectomy follows these specific steps:

Preoperative preparation: before surgery starts, the patients undergo blood tests and imaging studies to assess the extent of the prostate cancer.
Anesthesia: the patient is placed under general anesthesia to ensure they won’t feel pain during the operation.
Port placement: small keyhole incisions are made in the abdomen, through which thin tubes called trocars are inserted. The trocars serve as entry points for the robotic instruments and camera.
Robotic console setup: the surgeon then sits at a console a few feet away from the operating table and controls the robotic arms and instruments with hand and foot controls. The console provides a high definition 3D view of the surgical field.
Robot-assisted surgery: through the robotic arms, the surgeon manipulates the miniature instruments placed on them and inserts them into the keyhole incisions.
Prostate removal: using the robotic instruments, the surgeon carefully dissects and removes the prostate gland, being careful to ensuring not to damage the surrounding nerves and tissues responsible for urinary continence and erectile function.
Bladder neck reconstruction: after removing the prostate, the surgeon reconstructs the bladder neck and urethra to restore the urinary function.
Closure of the incisions: once the procedure is completed, the incisions get closed with sutures or surgical staples.

The benefits of prostatectomy as a robot operation

A prostatectomy performed with the help of a robotic system has many benefits, including:

A robotic prostatectomy is minimally invasive, resulting in smaller incisions, less pain, and a faster recovery compared to traditional surgery.
The robotic system provides with a magnified high-definition, 3D view of the surgical field, allowing for better visualization for more precise surgical maneuvers.
The precision of the robots and the improved visualization help minimize blood loss during surgery.
The use of a robot enables the surgeons to better preserve the nerves responsible for urinary continence and erectile function.
Patients who undergo a robotic prostatectomy typically experience shorter hospital stays and faster recovery times compared to those who undergo traditional surgery.

The Retzius sparing prostatectomy

There’s another type of prostatectomy used to cure prostate cancer that involves the preservation of the Rertzius space, a cavity located between the bladder and the public bone. It is the Retzius sparing prostatectomy.

It is performed by following these steps:

Patient positioning: the patient is typically placed lying on their back after undergoing general anesthesia.
Port placement: just like for the robotic prostatectomy, small incisions are made through which the trocars are inserted to provide access to the robotic instruments and camera.
Robotic console setup: the surgeon sits at the console and controls the robotic arms.
Retzius space dissection: with the robotic assistance, the surgeon carefully dissects through the Retzius space.
Prostate removal: once the Retzius space is entered, the surgeon removes the prostate gland, sparing the bladder neck and the urethra as much as possible.
Bladder Neck reconstruction: like for robotic prostatectomy, when patients undergo a robotic Retzius sparing prostatectomy, the bladder neck and urethra are reconstructed as well.
Closure: once the incisions are closed, the patient starts recovery time.

Cystectomy

Cystectomy is a surgical procedure involving the removal of the urinary bladder in case of bladder cancer, severe bladder dysfunction, or refractory interstitial cystitis. There are various approaches to Cystectomy, but in this article we’ll focus on the robotic-assisted one.

These are the steps of a cystectomy as a robot operation.

Operative evaluation: before the surgery, the patients might need to undergo a cystoscopy, imaging studies, or even biopsies to determine the nature of the bladder pathology.
Anesthesia: patients receive general anesthesia to ensure they are unconscious and pain-free during the robot operation.
Port placement: just like the other robot operations we listed above, cystectomy includes the port placement phase. Incisions are made to provide access for the robotic arms and the instruments attached to them.
Robotic console setup: the surgeon sits at the console and controls the robotic arms.
Bladder removal: the surgeon carefully dissects and removes the urinary bladder, along with any surrounding lymph nodes that may be involved. The ureters, which carry urine from the kidneys to the bladder, are detached from the bladder and reconnected to a segment of the intestine that is fashioned into a neobladder or diverted to an external bag.
Reconstruction: after bladder removal, the surgeon reconstructs the urinary tract to allow for the urine’s passage.
Closure: once the reconstruction is complete, the surgical incisions are closed with sutures or staples.

The benefits of a cystectomy

There are many benefits associated with a cystectomy operation. These include:

Improved survival rates: cystectomy can significantly improve survival rates when used for treat certain cases of bladder cancer, particularly when the cancer is confined to the bladder and has not spread to surrounding tissues or organs.
Relief from symptoms: cystectomy can provide relief from symptoms such as pain, bleeding, urinary frequency, and incontinence for people suffering from advanced bladder cancer or other conditions that severely affect the bladder’s functions.
Opportunity for reconstructive surgery: following a cystectomy, different reconstructive options are available to create a new way for urine to be stored and expelled from the body (like the creation of a neobladder).
Prevention of recurrence: cystectomy may be recommended in cases where bladder cancer is particularly aggressive or has a high likelihood of recurrence. Cystectomy works as a preventive measure to reduce the risk of the cancer coming back.

The nephrectomy

The nephrectomy is another minimally invasive surgical operation. In this case, the operation aims at removing one or both the patient’s kidneys.

A robotic nephrectomy follows 10 specific steps in order to be performed correctly:

Preparation: as for the other already mentioned robotic operations, the patient is positioned on the operating table, and general anesthesia is administered to induce unconsciousness and prevent pain during the surgery. The surgical team ensures that the robotic system and all the tools are set up and ready to use.
Port placement: the surgeon makes small incisions in the abdomen.
Trocar insertion: trocars are then inserted through the abdominal incisions and into the abdominal cavity. One of the trocars accommodates the camera, which provides a high definition 3D visualization of the surgical site.
Robotic arms setup: the surgeon positions the robotic arms and attaches specialized surgical instruments to them.
Docking the robot: the surgeon docks the robotic console near the operating table and sits at the console to control the movement of the robotic arms, while checking the surgical field through a high-definition monitor.
Tissue dissection and mobilization: using the robotic instruments, the surgeon starts dissecting and mobilizing the kidney and the surrounding structures. This may require the division and the sealing of blood vessels, the ligaments, and the connective tissues to free the kidney from its attachments to surrounding organs and tissues.
Renal artery and vein control: in this phase, the surgeon identifies and carefully divides the renal artery and the vein. The robotic instruments are used to clamp, cut, and seal these blood vessels to prevent bleeding.
Renal hilum dissection: the surgeon continues to dissect around the renal hilum (the area where the renal artery, the vein and the ureter enter and exit the kidney. This step is critical for safely removing the kidney without injuring adjacent structures.
Nephrectomy: once the kidney has been completely mobilized and the blood vessels and ureter have been divided, the surgeon removes the kidney from the abdominal cavity through one of the incisions. The kidney may be placed in a specimen bag for extraction to minimize the risk of contamination and spread of cancer cells.
Closure and recovery: the surgical team ensures that there’s no bleeding from the incision sites and that the abdominal cavity is free of any foreign bodies or residual tissue. The incisions then get closed with sutures or surgical staples. The patient is thus transferred to the recovery area for monitoring as they awaken from anesthesia.

The benefits of a robotic nephrectomy

The benefits of a robotic nephrectomy include:

Reduced trauma: since robotic nephrectomy involves making small incisions in the abdomen, a robotic nephrectomy results in less trauma to surrounding tissues and muscles.
Faster recovery: minimally invasive techniques – including robotic nephrectomy – are associated with shorter hospital stays, reduced postoperative pain, and faster recovery times compared to open surgery. Patients typically experience less blood loss, lower risk of complications, and a faster return to normal activities.
Better cosmetic outcome: the smaller incisions made on the patient’s body result in less scarring and improved cosmetic outcomes compared to open surgery.
Reduced risk of conversion: robotic nephrectomy may reduce the likelihood of conversion due to the enhanced visualization and instrument control provided by the robotic system.

The ureteroplasty

A robotic ureteroplasty is a surgical procedure used to repair or reconstruct a damaged or obstructed ureter (the tube that carries urine from the kidney to the bladder. Here are the general steps involved in a robotic ureteroplasty:

Preparation: preparation is crucial for a robotic ureteroplasty, too. Just like for the previously listed operations, the patient is positioned on the operating table, and general anesthesia is administered to them.
Port placement: the surgeon makes several small incisions in the abdomen in order for the small instruments attached to the robotic arms to pass through.
Trocar insertion: trocars are inserted through the abdominal incision anto into the abdominal cavity.
Robotic arms setup: the surgeon attaches the specialized surgical instruments to the robotic arms and positions them.
Docking the robot: the surgeon docks the robotic console and sits at it. The console allows the surgeon to control the robotic arms.
Identification of the ureteral injury or obstruction: using the camera attached to the robotic arm, the surgeon identifies the location and extent of the ureteral injury or obstruction.
Ureteral mobilization: the surgeon mobilizes the affected portion of the ureter, freeing it from surrounding tissues and structures. This may involve a careful dissection to expose and isolate the damaged or obstructed segment of the ureter.
Ureteroplasty repair or reconstruction: depending on the severity of the condition, the surgeon performs the appropriate repair or reconstruction technique.
Closure and recovery: once the ureteral repair or reconstruction is complete, the surgical team ensures that there is no bleeding from incision sites and that the ureter is functioning the way it should do. The incisions get closed with sutures or surgical staples. The patient is transferred to a recovery area for monitoring.

Main benefits of an ureteroplasty

The main benefits of an ureteroplasty include:

Improved urinary flow: ureteroplasty can restore or improve the flow of urine from the kidney to the bladder by repairing or reconstructing the damaged or obstructed portion of the ureter. This can relieve symptoms such as urinary retention and recurrent urinary tract infections.
Preservation of kidney functions: by addressing ureteral injuries or obstructions promptly, ureteroplasty helps to preserve kidney functions and prevent complications associated with untreated ureteral problems, such as hydronephrosis, which is the enlargement of the kidney due to the urine buildup).

Robotic retroperitoneal lymph node dissection (RPLND)

Robotic retroperitoneal lymph node dissection (RPLND) is a surgical procedure used in the treatment of testicular cancer, particularly in cases where there’s the risk of cancer spread to the retroperitoneal lymph nodes. The steps involved in this procedure are:

Preparation: the step of preparation is basically the same of the other operations listed above: the patient is positioned on the operating table and gets administered general anesthesia.
Port placement: the surgeon makes several small incisions in the abdomen or retroperitoneum.
Trocar insertion: the trocars get inserted through the abdominal or retroperitoneal incisions.
Robotic arms setup: the surgeon starts positioning the robotic arms and selects the instruments to attach to them.
Docking the robot: the surgeon docks the robotic console and sits at it.
Identification of the lymph node dissection targets: using the robotic camera and the instruments, the surgeon carefully identifies the location of the retroperitoneal lymph nodes to remove.
Lymph node dissection: the surgeon begins the process of dissecting and removing the retroperitoneal lymph nodes.
Specimen retrieval: once the lymph node dissection is complete, the surgical team removes the dissected lymph nodes from abdominal or retroperitoneal cavity. The lymph nodes may be placed in a specimen bag for extraction to minimize the risk of contamination and spread of cancer cells.
Closure and recovery: the surgical team ensures that there is no bleeding from the incision sites and that the abdominal or retroperitoneal cavity is free of any foreign bodies or residual tissue. The incisions are closed with sutures or surgical staples. The patient is then transferred to the recovery area.

The benefit of RPLND

RPLND show all the typical benefits related to robot operations, including the minimally invasive approach, the improved visualization and the cosmetic benefits. In addition to these, there’s another benefit that we can call “equivalent oncologic outcomes”: studies have shown that robotic RPLND can achieve comparable oncologic outcomes, including lymph node yield and cancer recurrence rates, to traditional open surgery. The patients can thus benefit from the advantages of a minimally invasive approach without compromising the effectiveness of cancer treatment.

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