Robotic surgery is a type of minimally-invasive surgery in which a surgeon uses a sophisticated surgical robot for precise control of surgical instruments during complex operations. Compared to open surgery, which uses large incisions, robotic surgery uses small surgical openings (about .5 to 1.5 centimeters) to access the anatomy. Surgeons use robotic arms to pass a high-resolution camera and tiny surgical instruments through the tiny openings, which gives surgeons a three dimensional view inside the body. and results in less trauma to the patient. Robotic surgery also offers a number of other benefits to patients.
Advantages of Robotic Surgery
- Less blood loss and reduced need for blood transfusions
- Smaller incisions and less scaring
- Less pain and need for pain medication
- Fewer complications
- Shorter hospital stay
- Faster healing and recovery times
Under the leadership of Dr. Akshay Bhandari, director of robotic surgery, our team of urologists utilize the state-of-the art da Vinci surgical system. The da Vinci robot's high-resolution camera, 3-D video monitor and miniature surgical instruments provide our surgeons the precision and dexterity required to safely perform the most complex procedures.
Urological Robotic Surgeries Performed at Mount Sinai Medical Center
- Radical Prostatectomy
- Partial and Radical Nephrectomy
- Retroperitoneal Lymph Node Dissection (RPLND) for testis cancer
Robotic prostatectomy is robotic assisted minimally-invasive surgery to remove the entire prostate for the treatment of prostate cancer. It is the most common treatment for prostate cancer, as removing the prostate gland before the cancer spreads offers patients the best chance for a cure.
For this operation, surgeons access the prostate through the abdomen with five or six small incisions. Once the prostate is removed in its entirety, the bladder is stitched to the urethra (the tube that drains urine to the outside of the body). A tube called a foley catheter is then placed in the bladder and urethra to drain urine while these organs heal. The catheter drains urine directly into an external bag. A drain is usually placed in one of the incisions to help rid the body of fluids that remain after surgery. In addition to this a drain is usually placed that is removed before the patient is discharged home.
Following robotic prostatectomy, patients are usually admitted overnight for observation. Most patients are eating and walking the day of surgery and their pain is relatively well-controlled with oral pain medications. After discharge, patients usually schedule an office visit five to seven days later for catheter removal. Robotic radical prostatectomy offers faster return of urinary continence and sexual function compared to open prostatectomy.
Robotic Partial and Radical Nephrectomy
Robotic kidney surgery is robotic assisted minimally-invasive surgery to treat various kidney conditions. The most common application of robotic kidney surgery is for the management of kidney tumors.
Most kidney tumors can be treated with a partial nephrectomy (surgery to remove only the tumor and spare the rest of the kidney). Leaving the patient with more healthy kidney tissue lowers the chance of long-term kidney failure and other conditions. Partial nephrectomy is a complex operation that requires stitching the kidney back together once the tumor is removed. However, the size and location of some tumors require the removal of the entire kidney through an operation called radical nephrectomy. Robotic assistance provides the precision and dexterity required to safely perform each surgery for even very complex tumors.
For a partial nephrectomy, surgeons usually access the kidney through the abdomen with four or five small incisions. Following this procedure, most patients are hospitalized overnight and can begin walking the next day. Most patients are discharged from the hospital one to two days after surgery.
For a radical nephrectomy, surgeons access the the kidney through the abdomen with four to five small incisions. Most patients are hospitalized for one or two days and can begin walking the day of surgery.
Robotic nephroureterectomy is robotic assisted minimally-invasive surgery to remove the entire kidney, ureter (tube that carries urine from the kidneys into the bladder) and a portion of bladder for the treatment of transitional cell cancer involving the kidney, the ureter or both organs. Open nephroureterectomy requires making two large incisions, one to remove the kidney and another to remove the ureter and portion of the bladder. With robotic surgery, the entire operation is performed using four to five small incisions.
Robotic pyeloplasty is robotic assisted minimally-invasive surgery to remove a blockage in the urinary system where the kidney (renal pelvis) drains into the ureter. This condition is called ureteropelvic junction obstruction. Robotic surgery provides the precision needed for suturing the ureter back to the renal pelvis, which helps restore the flow of urine.
Robotic cystectomy is robotic assisted minimally-invasive surgery to remove the bladder and surrounding pelvic organs for the treatment of advanced or high grade cancer in the bladder. Male patients typically require the removal of the entire bladder, prostate and surrounding lymph nodes. Female patients typically require the removal of the entire bladder, uterus and, occasionally, a portion of the vaginal wall and surrounding lymph nodes. Once the bladder is removed, surgeons must create a new bladder using a segment of the patient's bowel (neobladder) or create a passageway that drains urine from the kidneys, through an opening in the abdomen and into an external bag (urostomy).For this procedure, most patients are hospitalized for five to seven days.
Robotic sacrocolpopexy is the use of robotic assisted laparoscopic surgery to secure the vaginal vault (the top of the vagina) to the sacrum (the base of the spine where it connects to the top of the pelvis). This surgery is for women who experience partial or complete pelvic floor prolapse, a condition in which the pelvic organs (bladder, small bowel, urethra or vagina) drop out of place and push through the vagina. This condition most commonly affects women whose pelvic muscles and tissues are weak or stretched from childbirth or previous surgery.
Surgery is performed using five to six small incisions in the abdomen. In this procedure, a mesh structure is used to anchor the cervix or vaginal vault to the sacral bone, thereby restoring pelvic organs to their normal position. Patients are typically discharged from the hospital less than 24 hours after surgery.
Robotic adrenalectomy is the use of robotic assisted laparoscopic surgery to remove the adrenal gland. Adrenal glands are glands that sit on top of each kidney. The adrenal glands produce hormones like cortisol, aldosterone and adrenaline that serve several important functions in the body. Adrenalectomy is usually performed to remove a hyperfunctioning tumor that might be producing an excess of these hormones or to remove cancer that has developed in the adrenal glands.
Because the adrenal gland is located very near several vital organs (kidney, liver, spleen and pancreas), surgery to remove the adrenal gland is very complex. Robotic surgery provides the precision required to safely remove the adrenal gland while minimizing the likelihood of injury to surrounding organs. A robotic adrenalectomy is performed using four or five small incisions. Patients are typically discharged from the hospital within 24 hrs of surgery.
Robotic Retroperitoneal Lymph Node Dissection (RPLND) for testis cancer
Robotic retroperitoneal lymph node dissection (RPLND) is the use of robotic assisted laparoscopic surgery to remove the abdominal lymph nodes to treat testis cancer.
Robotic Ureterolysis is the use of robotic assisted laparoscopic surgery to free the ureter (the tube that drains urine from the kidneys to the bladder) from external pressure or fibrous bands (scar tissue) to prevent kidney damage.