Search

To report short- and medium-term oncological and functional outcomes of the first robotic-assisted laparoscopic radical cystectomy (RARC) series from the UK.Thirty patients underwent RARC between 2004 and 2007 at our unit. We report oncological and functional outcomes of this procedure in 20 patients (17 ileal conduit and three Studer Pouches), who have completed at least 6 months of follow up.There were 17 men and three women, median age 66 years (range 38-77 years). Median operating time was 330 min (range 295-510 min), and median blood loss 150 ml (range 100-1150 ml). There were two major complications (10%); a port site bleed and a rectal injury. The median follow up of this cohort is 23 months (range 7-44 months). One patient died of distant metastases at 8 months, and another developed a right ureteric tumour at 7 months. None of the patients had local pelvic or port site recurrence. The overall and disease-free survival are 95% and 90% respectively. Functional complications included a neovesico-urethral stricture at 3 months, a left upper ureteric stricture at 6 months and an incisional hernia at 12 months.Robotic-assisted laparoscopic radical cystectomy is an emerging minimally invasive procedure which at short- to medium-term follow up, in our experience, is oncologically and functionally equivalent to open radical cystectomy.

A surgical robot has been defined as “a computer-controlled manipulator with artificial sensing that can be reprogrammed to move and position tools to carry out a range of surgical tasks” (Dasgupta et al, 2005). The first fully automated surgical device used in clinical practice was developed by Wickham (Harris et al, 1997) to resect prostates in the 1980’s at Guy’s Hospital in London. Currently, robotic devices are available in many surgical specialities fulfilling an increasing number of roles. The most commonly used is the da Vinci™ master-slave system (Intuitive Surgical, Ca, USA). The da Vinci TM system is widely available commercially. It is composed of three components: surgeon console, patient-side cart and imageprocessing/insufflation stack. Its stereoscopic vision, motion scaling and EndoWrist™ technology with seven degrees of freedom (DOF) are major advancements. By far the most common procedure performed with the assistance of the da Vinci™ system is laparoscopic radical prostatectomy. Other urological procedures performed using robotic assistance include cystectomy, nephrectomy, partial nephrectomy, pyelolithotomy and pyeloplasty. Other specialities adopting this technology include cardiothoracic surgery, gynaecology, and general surgery. Ergonomically ineffectual instruments and monophasic monitors in laparoscopy are linked to surgeon’s musculoskeletal injuries and fatigue (Van Der Zee et al, 1997). Robotic surgery offers a different approach for the surgeon’s position, with added visual benefits and increased dexterity. Research in the ‘dry lab’ environment has shown that the robotic techniques, though somewhat slower, offered more precision than conventional laparoscopy (Nio et al, 2002). Laparoscopy naive surgeons have a shorter learning curve with robotic-assisted techniques compared with equivalent laparoscopic tasks. Research is ongoing in the assessment of fatigue when using robotic-assisted, laparoscopic and open techniques (Elhage et al, 2007). It is suggested that the improved ergonomic conditions offered by robotic systems may allow surgeons to operate more efficiently and with greater precision. As a result patients may have less morbidity and a shorter recovery time. O Access Database www.i-techonline.co m

Robotic technology is having a considerable impact on urological practice at the moment. With the increasing penetration of the da Vinci surgical system into hospitals around the world, surgeons are availing of the opportunities to use this technology to perform complex laparoscopic procedures. Nowhere is this more evident than in urology, where robotic-assisted laparoscopic radical prostatectomy is the most frequently performed robotic procedure of any kind. With the proliferation of this technology there are a number of questions raised. Apart from issues regarding efficacy and economics, complication rates specific to the technology as well as the procedure need to be addressed. This article reviews the current status of complications in robotic urological surgery with respect to both machine-related issues, and procedure-related issues.