Surgeons increasingly are using robotic surgery to operate on patients, resulting in less blood loss, less pain and faster recovery. Since 2003, UCLA urologic surgeons have performed more than 3,000 procedures robotically to treat prostate, bladder and kidney cancer.
The robots don’t do the surgeries themselves; a surgeon and a dedicated team control the robotic arms and their highly maneuverable “endowrists,” which grasp the surgical instruments, from a console as they operate through small incisions. A high-definition image of the surgical field is provided by a camera that is inserted through a separate incision.
Robert Reiter, MD, director of UCLA’s Prostate Cancer Program, operated with his hands for 13 years before moving to robots in 2003. “It’s almost hard to remember [what it was like],” Dr. Reiter says. “The robots provide a far better operation. They’re more precise. There’s far less blood loss. There’s better visualization. It’s less invasive and less painful.” In traditional laparoscopic surgery, Dr. Reiter adds, “the instruments did not have any rotation so they didn’t function like a human hand. There was only two-dimensional vision. In robotic surgery, there is magnification, and you can get to places through smaller incisions. All of these things provide significant advantages.”
Robots were first used in urologic surgery for prostate-cancer surgery, followed by bladder and kidney-cancer procedures. In addition, urologic surgeons use the robots to treat enlarged prostates, incontinence for both men and women and testicular cancer.
The technology has improved dramatically, Dr. Reiter says. “It’s almost like a television. Imagine going from analog to digital and now high definition...the instruments have gotten better, the robots have gotten better.”
Technological advances have broadened their capabilities. Now, for example, surgeons use robots to not only remove cancer tumors from diseased bladders, but also to remove and then reconstruct and reinsert them. During kidney surgeries, surgeons can remove the entire kidney, or just the tumor. Recently, they have been performing kidney transplants using a robot.
Surgeons are integrating robotic surgery with better imaging to create precise maps of the prostate and the kidney before they remove them. In aggressive forms of prostate cancer, surgeons are using a green fluorescent dye, ICG, to identify the primary location to which the cancer has spread, called the sentinel lymph node. For kidney cancer, surgeons use the same dye to identify the vascular structure of the kidney so that they can remove the blood vessels supplying the tumor rather than the normal vasculature.
In addition to urology, robotic surgery is utilized in many different fields, including head and neck surgery, general surgery, cardiac, gynecology and thoracic surgery. “There’s really not anything we’re not using it for these days,” Dr. Reiter says.