Urological Surgery Robotic Surgery in Urology Franklin E Kuehhas1 and Markus Hohenfellner2 1. Urologist; 2. Professor and Chairman, Department of Urology, University of Heidelberg Medical School
Abstract
Minimally invasive surgery has revolutionised therapy modalities in different areas of modern medicine. Urologists have been some of the first to implement the advantages of the minimally invasive surgical approach. Recently, robot-assisted surgery has emerged and has led to a significant change in urology. In particluar, robot-assisted radical prostatectomy has received widespread acceptance. Current literature presents data on the efficacy and safety of various robotic procedures, but there are also some downsides that must be kept in mind. The issue of cost in particular seems to be a major problem for robotic surgery. Future developments will show whether the robotic revolution will proceed. This article provides a short update on the history of robotic surgery and focuses on new developments in the field of robotic surgery in urology.
Keywords
Robotic surgery, robot-assisted radical prostatectomy, robotic partial nephrectomy, robot-assisted radical cystectomy, robot-assisted urogynaecological surgery, robotic pyeloplasty, robotic adrenalectomy, robotic paediatric surgery, robotic sacrocolpopexy
Disclosure: The authors have no conflicts of interest to declare. Received: 27 May 2010 Accepted: 22 July 2010 Citation: European Urological Review, 2010;5(1):69–77 Correspondence: Franklin E Kuehhas, Im Neuenheimer Feld 110, 69115 Heidelberg, Germany. E:
franklin-emmanuel@web.de
The aim of minimally invasive surgery is to decrease hospital stay, post-operative pain and overall surgical morbidity while attempting to make procedures more precise and technically easier. The last century has been full of paradigm shifts in therapy schemes and surgical approaches. In particular, robotic surgery has led to modifications of previously fixed indications for open surgery. Robotic surgery is currently used for reconstructive procedures as well as primarily extirpative surgical approaches. This article on robotic surgery in urology will provide a short overview of the various operational areas where robotic aids can be seen. Numerous procedures are performed with the help of robotic components nowadays, and the world of radical prostatectomy in particular has changed tremendously during the last decade with the emergence of robotic surgery.
History and Background
Karel Capek can be seen as the inventor of the now popular word ‘robot’: it derives from his play ‘Rossum’s Universal Robots’.2
The
meaning of robot originates from the Czechoslovakian term ‘robota’, meaning forced work.
Our comprehension of the word robot is a computer-controlled manipulator with artificial sensing that can be programmed to move and position tools so as to carry out a range of surgical tasks.3 A modern robot relies on three key elements: programmability (a robot is a computer), mechanical capability (a robot is a machine)
© TOUCH BRIEFINGS 2010
Minimally invasive surgery has revolutionised therapy modalities in different areas of modern day medicine. Urologists have been some of the first to exploit the advantages of the minimally invasive surgical approach.1
and flexibility (the robot must be able to carry out instructions).4 When talking about robots, one must distinguish between active, semi-active and master–slave systems.5
The popular da Vinci robot
platform used in urological surgery is a perfect example of a master–slave system. In master–slave systems the surgeon operates the robot from a workstation without actually touching the patient. In contrast to the robotic systems used in orthopaedic surgery, the da Vinci platform does not fulfil pre-programmed tasks. It will only perform according to what the surgeon sitting at the master console tells it to do.
The first appearance of a robotic aid in urology was in 1989, when Davis et al. published results of the PROBOT.7 The PROBOT used a robotic frame to guide a rotating blade (40,000rpm) to complete a transurethral resection of the prostate. Initial studies where performed on prostate-shaped potatoes and the results were promising. Although the device demonstrated its safety and effectiveness in five patients, it never made its way to mass production.8
Robot-assisted procedures were first performed in 1985, when Kwoh et al. utilised a modified industrial robot to aid in drilling and biopsies during computed tomography (CT)-guided stereotactic brain surgery.6
Current Technologies
In 1993 the US Food and Drug Administration (FDA) approved the Automated Endoscopic System for the Optimal Positioning (AESOP) device (Computer Motion, Berkely, CA, USA).9
The AESOP is a
table-mounted robotic arm with seven degrees of flexibility. This system uses voice or pedal control to direct the movements of the
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