Robotic surgery of urological tumors

Tumors of the urinary system are widespread and can range in size from small, benign tumors to carcinomas with a high mortality rate. The predominant malignant tumor in the urinary tract is bladder cancer. Here is the latest technology for treating urological and bladder tumors with a surgical robot.

Surgical robotic cystectomy is a procedure to remove part or all of the bladder using small instruments attached to precise robotic arms, to provide the highest level of safety and comfort to the patient instead of going for traditional surgery. 

The surgical robot enhances the process by providing high-resolution 3D vision and improving the use of surgical tools. At the control unit, the surgeon controls the robotic arms holding the surgical instruments through precise movements to perform the procedure. The robot does not carry out the surgery, but the surgeon controls the surgical tools through the control unit that controls the arms of the robot.

Partial cystectomy involves removing the bladder's cancerous portions only. In early stages of cancer, a partial cystectomy is performed, preserving the remaining bladder tissue. Unfortunately, a partial cystectomy cannot carried out if the malignancy has spread to the muscle layer.

Radical cystectomy involves removing the entire bladder, including nearby lymph nodes, part of the urethra, and any other nearby tissue that may contain cancerous cells. In men, it may also be necessary to remove the prostate, urethra, and sperm vesicles. Women may also have their urethra, uterus, ovaries, fallopian tubes, and a portion of their vagina removed.

Prof. Mahmoud AbdElHakim, Professor of Urology Cairo University, decides the type of surgery required.

A robotic system and small devices are used during a robotic cystectomy to remove the bladder surgically. It is a more effective and less invasive procedure. Instead of performing the surgery with the surgeon's hands, the surgeon controls robotic arms that mimic his movements. Due to its exceptional accuracy, surgical robotic cystectomy has become the preferred method for treating bladder cancer.

Prof. Mahmoud AbdElHakim operates automated tools while maintaining complete control of the process, as follows:

• Under general anesthesia, the abdomen is inflated with a safe amount of carbon dioxide to extend the abdominal cavity and provide a working space for the surgeon.

• Small incisions are made in the abdomen so that precise surgical instruments, including a high-magnification camera, can be inserted into the body cavity.

• Prof. Mahmoud AbdElHakim uses a  surgical robot to separate cancerous cells, which may include the bladder, nearby lymph nodes, and surrounding organs. The bladder is separated internally and then removed through one of the incisions.

• The urinary tract is also being reconstructed using a robot to create an alternative way for the body to store urine without the surgeon's or medical team's hands entering the body cavity.

During radical cystectomy, the surgeon reconstructs the urinary tract to restore normal urinary tract function. The reconstructive procedure depends on several factors, including the reason for the surgery, the patient's health, and personal preferences, which may include several ways, such as:

• Prof. Mahmoud AbdElHakim may use a long section of the small intestine to create a urine storage tank. One end of the reservoir is connected to the ureters, which transport urine from the kidneys to the bladder. The urethra is attached to the reservoir's other end (the tube that carries urine out of the body). Therefore, urine passes similarly to before surgery. The patient empties the tank periodically by relaxing the pelvic muscles and tightening the abdominal muscles, allowing normal urinary tract function.

• Prof. Mahmoud AbdElHakim may separate a short section of the small intestine to create a tube extending from the kidneys to the abdominal wall, connecting one end to the ureters and the other to an opening in the skin near the navel. A plastic device is placed over the skin opening to collect urine.

Using surgical robots to treat urological tumors shows numerous benefits over traditional and laparoscopic surgery, as follows:

• The technology used in the surgical robot enhances the accuracy, control, and flexibility of the surgeon's movements. The robotic wrist has a wider range of motion than a human wrist because the robotic arms may move in several directions and at larger angles. It allows the surgeon to perform precise and complex movements that are not possible with the human hand alone, even in the case of the laparoscope; This enhances the accuracy of the surgery.

• Surgical robot technology improves surgical visualization as it provides high resolution and 3D vision; this allows the surgeon to distinguish the vital muscles and tissues surrounding the bladder, which increases the chance of preservation.

• Robotic cystectomy also has the usual benefits of minimally invasive surgery, which are:

- Reduced hospitalization period.

- A shorter recovery period due to the small size of the surgical incisions.

- Less blood loss and less risk of infection

- Reducing the possibility of surgical complications.

- Less pain and a decreased need for analgesics.

- Minimal scarring at the surgical site.

- Lowering the risk of post-surgical urinary incontinence, impotence, and other complications associated with cystectomies.

Cystectomy is a major surgery. Any major surgical procedure carries risks. However, the robotic surgical technique is very safe compared to traditional surgery. It is now considered the gold standard against which all techniques are measured, because robotic surgery significantly reduces the risks of several side effects.

The patient may notice changes in how to urinate after surgery. The bladder is smaller after a partial cystectomy, so he may need to go to the bathroom more often. In the case of a radical cystectomy, the ability to urinate depends on the type of the reconstructive surgery.

Men may have difficulty getting and maintaining an erection since the surgeon may remove the seminal vesicles and prostate along with the bladder during a radical cystectomy.

If the women's uterus or ovaries are removed during a radical cystectomy, they may potentially go through early menopause or lose their ability to conceive.

A robotic cystectomy requires substantially less recovery time than a traditional or even laparoscopic procedure. The recovery period depends on the type of surgery. Typically, individuals who have partial cystectomies recover more quickly than those who undergo radical cystectomies.

Many patients experience poor appetite and abnormal bowel function (constipation, loose stools, or both) immediately after radical cystectomy, as a result of using a portion of the intestine for urethral diversion.

• Once the condition is stable, the patient can drink fluids and follow a specific diet as his condition improves. The patient is also encouraged to start walking as early as possible to prevent complications.

• Once home, the patient is encouraged to be active, although no exercise, weight lifting, or excessive climbing of stairs is recommended for at least 6 weeks.

Prof. Mahmoud AbdElHakim, Professor of Urology Cairo University, is with you step by step until your complete recovery if you suffer from urological tumors through the most accurate and least invasive technique with the surgical robot.