Robotic Surgery in Electrophysiology

Prostate cancer: If cost is not a factor, then robotic surgery is the best way to remove the entire prostate harboring cancer. Again, the role of a surgeon sitting on the robotic console is important than the robot itself. Robot is just a tool to help surgeon perform a better surgery. Apart from the usual advantages of minimally invasive surgery as discussed earlier, it helps in early discharge, and early removal of the urethral catheter to which patients find the most uncomfortable experience. Robotic surgery may not be useful for benign or nonmalignant enlargement of the prostate causing symptoms, wherein endoscopic removal gives similar advantages as minimally invasive surgery.
Kidney cancer: Kidney cancers, when picked up early on ultrasonography of the abdomen, then normal part of the kidney can be saved by removing a part of the kidney containing tumor. This is called partial nephrectomy, which can be done with the Robot Assistance. Though laparoscopy comes handy too but robot scores over it by giving better magnification, suturing of the defect created by removal of the tumor and better vision to have a safe and complete removal of the tumor. It has advantages of minimally invasive surgery more so in obese patients. In some patients, who have tumor extension in the inferior vena cava, robotic approach avoids a major muscle cutting incision.
Bladder cancer: When the patient with bladder cancer requires removal of the bladder with urinary diversion, then robot provides a comfortable platform to the surgeon to finish the surgery with less blood loss and pain. It is called radical cystectomy and lymph node removal with ileal conduit or orthotopic neobladder formation.
Upper tract TCC: Cancer of ureter or renal pelvis (inner lining of the kidney is best treated with complete removal of the unit from kidney to the lower end of the ureter entering the bladder. This is made easy with robot assistance as robotic arm would have a wide range of movement to cover the dissection from the kidney to the bladder.
Testicular cancer: Robot is the best tool to remove lymph nodes in the abdomen, if they are involved by the testicular tumor. These lymph nodes are present at the back side of the abdomen so are called retroperitoneal lymph -nodes. The procedure of removal of lymph nodes is called Retro Peritoneoscopic Lymph Node Dissection (RPLND).
Inguinal lymph node dissection for penile cancer: Carcinoma of the penis spreads to the lymph nodes present in the groin area or called inguinal area. Open surgery has variety of complications but with the help of robot assistance one can achieve the similar goal with less morbidity. This procedure is called Video Endoscopic Inguinal Lymphadenectomy (VEIL) is an option to choose from.
For Benign conditions of the urinary system (ablative surgery)
Adrenalectomy: this is the gland located above the kidney and needs to be removed when it causes hormonal disbalance i.e., pheochromocytoma or Hyperaldosteronism. Sometimes these glands required to be removed when they turn cancerous.
Nephrectomy: Robotic surgery is an alternative to laparoscopic surgery to remove the entire kidney.
Varicocelectomy: Robot assistance comes handy to ligate the veins individually in varicocele.

Use of the robot is an evolving indication for kidney transplant, particularly in obese recipients, where in the complications of open surgical wound are slightly higher than usual. Though it gives advantages of minimally invasive surgery, superior outcomes in terms of kidney graft function have not yet been established.
For Benign conditions (Reconstructive surgery)
Pyeloplasty: This is a procedure done for pelvic-ureteric junction obstruction PUJO, where flow of urine from kidney to ureter gets obstructed resulting in enlargement of the kidney. Robotic surgery is useful in suturing, which otherwise is a challenging task using conventional laparoscopy.
Ureteric reimplantation: Done for vesicoureteral reflux or ureter vesical junction obstruction due to various reasons.
Boari flap reconstruction: Done for a long segment lower ureteric stricture, wherein a new segment of the ureter is formed using bladder wall to bridge the gap.
Bladder augmentation: In certain conditions like chronic infection, neurogenic cause or tuberculosis, where the bladder capacity is reduced, robotic surgery comes handy to increase the capacity of the bladder using small intestine.
Vesicovaginal fistula: abnormal connection between urinary bladder and vagina causing continuous urine leak.
Colpo suspension: for urinary leak known as stress incontinence in women.
Cystocele and rectocele repair: for prolapse of bladder or the rectum into the vagina causing urinary symptoms.
Urethral reconstruction in females:
In females when there is a complete loss of the urethra with urinary incontinence, a new urethra can be constructed from the urinary bladder itself using robot assistance.

The prostate gland, located at the base of the penis and below the bladder, is about the size of a walnut. Cancer tumors can develop within the prostate gland. Depending on your age, overall health, cancer stage and personal preferences.
Your doctor may recommend:
1. Watchful waiting or active surveillance
2. Chemotherapy
3. Hormone therapy
4. Cryotherapy
5. Immunotherapy
6. Surgery

You and your surgeon may determine surgery, called a radical prostatectomy, is necessary. During a radical prostatectomy, your surgeon will remove your entire prostate gland and, possibly, some surrounding tissue and lymph nodes.

This procedure includes a robotic cart with arms that help in holding the instruments, it contains a camera that gives a 3D picture of the surgical site along with it gives the benefits that help the twisted.
It gives a number of benefits to the patients including –
- Less blood loss with reduced need for transfusion
- Low postoperative pain and discomfort
- Less scarring with a lower risk of infection
- Quicker recovery that helps return to normal activity sooner than other methods of surgery

One of the main benefits of robotics in urologic surgery are that it helps in returning of erectile dysfunction in a speedy manner, improving urinary incontinence within 6 months of the surgery. Besides this, there is also reduced loss of blood with a lower risk of wound infections and complications. Hospital stay time is reduced along with the recovery time.