Robotic Laparoscopy

The 5 main advantages of robotic laparoscopy (compared to the straight-stick one)

The robotic laparoscopic surgery is a minimally invasive treatment used by urologists. It is one of the greatest medical innovations in the urology field of the last 20 years.
Just like the name suggests, it is a surgical technique that allows to inspect the abdominal cavity of the patient. As a minimally invasive treatment, it doesnt’t require making large incisions in the patient’s skin, leaving no scars on it, and doesn’t need long post-operation recovery times.

Urological surgery, when it’s needed

Urological surgery is a medical field specifically focused on treatments for the diseases that affect the organs and the body structures of the urinary system and the male genital system. These include the kidneys, the urinary tract, the urinary bladder, the uretra, the prostate, the testicles and the penis.

The person who performs urological surgery operations is the urologist, a doctor specialized in conditions that affect these specific human organs and structures. In some cases, the urologist may perform an urological laparoscopy on the patient.

What is an urological laparoscopy?

The laparoscope is a thin tube with an optical system and a light source attached to it. Thanks to this tool, the doctor can observe the internal structures of the patient and identify possible diseases.

During the surgical operation, the laparoscope gets introduced inside the patient’s abdomen. The tool has a camera attached to it, which allows the doctor to inspect the pelvic organs projected by a monitor in real time. If necessary, the doctor can introduce other instrument inside the patient’s body, like forceps or scissors, through the laparoscope itself.

Being a minimally invasive treatment, laparoscopic surgical incision usually measure from 0,1 to 0,5 inches. In the past, old urological surgery operations were carried out with 4 to 7 inches incisions.

Why is laparoscopy performed? (The diseases)

Laparoscopy gets performed for both diagnostic and therapeutic purposes.
It is used mainly for prostathic and kidney diseases, including:

Kidney cancer, which represents 2% of all the neoplastic diagnosis on a global scale.
Malignant testicle cancer, including seminomas, non-seminomas, lymphomas, and sarcomas.
Bladder cancer, which mainly affects people who are over 60 years of age.
Prostate cancer, one of the most frequent types of cancer that affect men.
Urinary tract infections, which usually have bacterial origins. Women are usually more affected by them.
Urinary incontinence, which is more frequent in women and usually strikes people of old age.
Kidney and ureteral stones, which are usually caused by unhealthy eating habits.
Hypogonadism, which is an insufficient production of testosterone.
Benign prostatic hypertrophy (BPH), which ususally affect people who are over 50 years of age and is characterized by a prostate swelling.

Difference between robotic surgery and laparoscopy

Many people wonder what could be the differences between robotic surgery and laparoscopy, and what kind of advantages and disvantages these two different operating methods bring with them.

The straight stick laparoscopy has been established since the years 2010s as the standard method for urological surgery. Despite its proven benefits though, the adoption of this minimally invasive surgery method was slow, while laparotomy remained the dominant method.

The robotic assisted laparoscopy was introduced with the Da Vinci Surgical Systsem, approved by the FDA for gynecologic surgery in 2005. It is a minimally invasive method as well, and during these procedures the doctor is physically distant from the patient and sits at a console equipped with a three-dimensional monitor. The console is equipped with a complex system of controls that translate the doctor’s hand movement onto the robotic arms. A digital video camera and thin surgical instruments are attached to these robotic arms.

Advantages and disvantages of the robotic assisted laparoscopy

The Davinci laparoscopy shows some improvements compred to the straight stick one:

Smaller instruments;
7 degrees of movement;
Three dimensional immersion vision with no fulcrum effect;
Neutralization of tremor;
Control of the camera by the primary surgeon.

There are also some potential disvantages to it:

Lack of haptics;
Higher cost. A robotic laparoscopy cost is usually around $3000–$6000.

Robotic laparoscopy requires a particular setup of the room and additional time for the docking process, but it guarantees a better visualization and a better manipulation, two things that can accelerate some of the most complex procedures.

Robotic surgery is also used to treat endometriosis. The endometriosis is a condition in which a tissue similar to the inner lining of the uterus grows outside of it, often affecting the ovaries, the fallopian tubes and the pelvic’s tissues, causing pain.

Urological laparoscopy preparation

Not every patient can undergo an urological laparoscopy. It’s prefereable to avoit it for patient affected by pathological obesity or chronic obstructive pulmonary disease (COPD). People who underwent other surgical treatments that can interefere with it must avoid ita s well.
If a person is affected by these factors, they must undergo specific clinical analyses and check out their health state before undergoing an urological laparoscopy. For istance, it’s possible that the patient may need to avoid eating for a while before starting the surgical procedure.

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Firefly laparoscopy

Firefly laparoscopy, also known as fluorescence imaging or fluorescence-guided surgery, is a type of medical technique used in minimally invasive surgeries. It involves using a special fluorescent dye called indocyanine green (ICG) that is injected into the patient. When illuminated by near-infrared light, the dye fluoresces and emits a green color, making the structures that have absorbed it appear bright against a dark background, making them easier to examine through an enhanced visualization.

The future of robotic surgery

Itis estimated that in the (maybe near) future it twill be possible to do surgical operations remotely.
A prototype of remote interviention has already been carried out for demonstration purposes (it was called Lindbergh operation, carried out in 2001), although the costs are still to high and the advantages have yet to be demonstrated. The Da Vinci Surgical System might be the right step towards the future of surgery, but maybe a lot more has to be done to further improve what the connection between robotics and medicine can bring to the table.

If you need any advice about traditional or robotic laparoscopy, don’t hesitate to contact me!