Radical prostatectomy, partial nephrectomy and UPJ repair are all procedures which are now routinely performed by our surgeons using the da Vinci robot. In addition to these operations, however, there are other surgeries that they perform robotically that, in many cases, are even more specialized.
Robotic Radical Cystectomy
Bladder cancer is most commonly confined to the wall of the bladder. However, a subset of patients will have tumors that are no longer limited to the superficial lining of the bladder. This type of “invasive” bladder cancer requires aggressive surgical management since such tumors, if left untreated, can have lethal consequences. The standard surgical procedure is termed a “radical cystectomy”. In men, this implies that the bladder, prostate, and pelvic lymph nodes are all removed. In women the standard surgical procedure involves removal of the bladder, uterus, fallopian tubes, ovaries, cervix, anterior vaginal wall, and urethra along with the pelvic lymph nodes. Because the bladder is no longer present as a urine reservoir, the urine must be diverted either out of the body or into a newly constructed reservoir, also known as a “neobladder”. The hospital stay is generally five to seven days and patients usually return to work and normal daily activities in four to six weeks. These operations can now be performed robotically with the advantage of a decrease in intraoperative blood loss. Few surgeons in the mid-Atlantic region have the experience that Dr. Mordkin has performing radical cystectomy operations using the da Vinci robot.
Robotic Laparoscopic Nephroureterectomy
This procedure is performed to eradicate cancers that form from the cells that line the inside of the kidney and ureter. These cancers can often be aggressive, and, therefore, surgery is usually indicated. The traditional operation consists of removing the kidney and the entire ureter. In years past, a standard 12th rib flank incision was used to remove the kidney and a second incision in the lower abdomen was used to complete the removal of the ureter. This procedure can now be performed laparoscopically and roboticallywith outcomes that are equal to the open operation but have the advantage of smaller incisions, less pain and decreased blood loss. Three to four small incisions are used to dissect the kidney and the ureter and then a separate “cesarean section-like” incision is created to remove the kidney and ureter intact.
Robot-assisted Laparoscopic Ureteropelvic Junction Repair
An ureteropelvic junction obstruction (UPJO) is a blockage of urine as it drains from the kidney into the tube which ultimately empties into the bladder. This blockage, either congenital (meaning that you are born with it) or acquired, most commonly results in flank or back pain because the urine can not properly drain out of the kidney. Other complications of an ureteropelvic junction obstruction are infection, compromised kidney function on the affected side, and infection. The classic method for repair involved an open incision to approach the obstruction. The narrowed UPJ was then excised and the two ends were sewn back together. The procedure can now be performed laparoscopically with assistance of the daVinci robot. The results are comparable to the open approach with pain medication requirements and length of hospital stay being significantly reduced compared to an open surgical approach. This translates into patients returning to work and their activities of daily living sooner. The surgery is performed with a general anesthesia. Four small (1 cm) incisions are made in the abdominal area. The kidney is exposed and the specific UPJ pathology is identified. The appropriate repair is chosen and carried out with the daVinci robot. Just prior to completing the repair, a small piece of plastic tubing called a “stent” is introduced down the ureter. The stent serves to facilitate urinary drainage across the repaired region. The stent is then removed with a simple office procedure six weeks after the surgery. Patients will typically spend one night in the hospital. A catheter that empties the bladder and a drain that emerges from one of the small incisions are removed prior to discharge. The risks include pain, infection, bleeding, injury to surrounding organs, urine leak from the repaired region, and recurrence of the obstruction