Robotic Surgery in Urology

What is da Vinci Xi?

The da Vinci Xi is a robotic surgical system used for minimally invasive surgeries, including prostatectomy for prostate cancer. Developed by Intuitive Surgical, it is the latest iteration of the da Vinci Surgical System, designed to provide enhanced capabilities and precision in surgical procedures.

Since its introduction in 1998, over 10 million procedures have been performed using this platform cementing its status as the preferred robotic system for surgeons worldwide with an excellent safety record.

Why perform Robotic Surgeries?

The da Vinci Xi robotic system is an evolution of traditional keyhole surgeries which is able to significantly benefit patients through several key innovative advancements.

This minimally-invasive surgical technique allows high-definition 3-dimensional vision with up to 10-times magnification and allow unparallel precision even when performing complex surgeries minimising complications and promotes faster post-surgical recovery for patients.

Precision is crucial in surgeries because even the smallest deviation can have significant consequences. The EndoWrist® instruments allow 7-degrees of motion, surpassing that of a human wrist and allows precise movements within the surgical field ensuring that surgeons cut precisely what needs to be cut, whether it's removing diseased tissue or performing a specific procedure, while preserving vital structures to maintain function and minimise complications.

Which urological conditions will benefit from the robotic approach?

Many surgeries benefit from the added precision and control afforded by the robotic platform however the two surgeries most performed with robotic assistance due to the significant advantages over the traditional keyhole approach are:

1. Prostate Cancer Removal (Radical Prostatectomy)
2. Kidney-preserving Surgeries for Kidney Cancers (Partial Nephrectomy)

Radical Prostatectomy

Robotic radical prostatectomy is a minimally invasive surgical procedure used to treat prostate cancer. It involves the removal of the entire prostate gland and surrounding tissues using robotic assistance.

Robotic radical prostatectomy is considered an effective treatment option for localized prostate cancer and has become increasingly popular due to its benefits for patients which includes reduced complication rates and faster recovery time.

A typical surgery takes between 3 to 5 hours depending on the complexity of your tumour and involves multiple critical steps which benefits greatly from the precision and control enabled by the da Vinci Xi system.

1. Erectile function preservation: The 3D camera provides a magnified, high-definition view of the surgical site, allowing the surgeon to see the prostate gland and surrounding tissues with great clarity. Using the robotic instruments, the surgeon carefully dissects and removes the prostate gland while preserving surrounding nerves and tissues responsible for urinary and sexual function.
2. Suturing of the bladder to water pipe: Wristed instruments allows movements mimicking those of the human hands inside your body ensuring every stitch is accurately placed reducing the rates of urine leakage after surgery.
3. Reduced blood loss and complications: The robotic system provides enhanced visualisation and precise movements, allowing for more accurate removal of the prostate gland while minimizing damage to nearby structures.

Partial Nephrectomy

Partial nephrectomy is a surgical procedure used to remove a portion of the kidney while preserving the rest of the organ. It is typically performed to remove small kidney tumours while sparing the healthy portion of the kidney and is particularly important in patients whose kidney function has been reduced due to other long-term illnesses or has only one functional kidney.

This surgery takes about 2 to 3 hours and the da Vinci system brings many added benefits compared to traditional keyhole surgery.

1. Clear margin of resection: The camera clarity and magnification allows clear visualisation of the kidney tumour ensuring that your surgeon is able to remove them effectively while preserving as much of the normal kidney as possible to reduce the risk of chronic kidney failure.
2. Reducing blood loss: After the tumour is removed, the surgeon repairs the kidney to ensure its normal function. It is very important to suture every major blood vessels and urine tract to reduce the risk of bleeding and urine leakage after the surgery and the da Vinci system allows accurate closure of these structures.

If you are interested to undergo a robotic surgery, please schedule an appointment with your preferred urologist in Gleneagles Hospital Penang 

Written by: Mr Aaron Goh Yue Keng