Robot-Assisted Urologic Procedures

Parts of the Body InvolvedProstate glandBladderRectumUrethraUretersKidneysUterusVagina Reasons for Procedure Robot-assisted urologic procedures are performed to treat a variety of conditions, including: Urinary tract obstructions from a variety of causes: Kidney stonesProstate cancerBladder cancerKidney cancer and other diseases of the kidney Risk Factors for Complications During the Procedure A risk factor is something that increases your chances of having complications during your procedure. Risk factors for complications during robot-assisted urologic procedures include: Pre-existing lung, heart or kidney diseaseObesityExcessive alcohol intakeSmokingUse of certain prescription medicationsDiabetesAdvanced age What to Expect Prior to ProcedureDepending on the reason for your surgery, your doctor may do the following:Physical examBlood testsUrine testsElectrocardiogram (ECG, EKG)a test that records the electrical currents passing through the heart muscle Intravenous pyelogram (IVP)a type of x-ray that creates images of the kidney, ureters and bladder by injecting dye into the bloodstream Retrograde uretograma type of x-ray that create images of the bladder, ureters and kidneys by injecting dye into the bladderKidneys, ureter, bladder (KUB)an x-ray of the abdomen Ultrasounda test that uses sound waves to visualize the inside of the body CT scana type of x-ray that uses a computer to create images of structures inside the chest MRI scana test that uses powerful magnets and radiowaves to create images of structures inside of the chest Cystoscopya lighted tube equipped with a camera used to visualize the inside of the urethra and bladderReview your medications with the surgeon; you may need to stop taking some of themFollow a special diet, if recommended by your surgeonTake antibiotics, if prescribed by your doctorShower the night before your procedure using antibacterial soap, if your doctor asks you toArrange to have someone drive you to and from the procedure, and for help at home after your procedureEat a light meal the night before , and do not eat or drink anything after midnight unless told otherwise by your doctorPlan to wear comfortable clothing on the day of your procedure AnesthesiaGeneral or local anesthesia with sedation will be given, depending on the procedure.

Description of the ProcedureThe surgeon cuts several small (approximately one-centimeter) keyhole incisions in the abdomen. A needle may be inserted through one of these openings to inject carbon dioxide gas into the abdomen, making it easier for the surgeon to see internal structures.The surgeon passes a small camera (endoscope) through one of the incisions, which lights, magnifies, and projects an image of internal organs onto a video screen for the surgeon to view. The endoscope is attached to one of three or four of the surgical systems robotic arms.The other two or three arms hold other instruments such as dissectors, scissors, scalpels, and/or forceps. These instruments are able to grasp, cut, dissect, and suture structures inside the abdomen during the operation. Instrument Used in Procedure 2008 Nucleus Medical Art, Inc. While sitting at a console several feet away from the operating table, the surgeon looks through lenses at a magnified, three-dimensional image of the inside of the abdomen. Another surgeon stays by the patient during the procedure, where he or she can adjust the camera and instruments as needed.With joystick-like hand controls and foot pedals, the surgeon at the console guides the movement of the robotic arms and surgical instruments. The robotic arms are able to perform surgical tasks with an increased range of motion than would be possible using traditional surgical techniques. In addition, the robotic arms can filter out hand tremor and translate the surgeons larger hand movements into smaller ones.

After the endoscope and other instruments are removed, the surgeon closes the incisions with sutures or staples, and applies a sterile dressing. After the ProcedureDepending on the reason for the procedure, some of the tissue that was removed may be sent to a pathologist for examination (eg, in the case of prostate, bladder, or kidney cancer). How Long Will It Take?Usually 2-4 hours, but this depends on the type of procedure being done. Will It Hurt?General anesthesia prevents pain during surgery. Patients typically experience pain and soreness during recovery, but receive pain medication to relieve the discomfort. You may also feel bloated or have pain in your shoulder from the gas used during the procedure. This can last up to three days. Possible ComplicationsUrinary incontinenceinability to control urinary stream Erectile dysfunctionRetrograde ejaculationsperm ejaculates into your bladder, rather than out through the urethra; this may cause urine to appear milky white after ejaculationInfertilityUrethral strictureabnormal narrowing of the urethraDamage to neighboring organs or structuresInfectionBleedingAnesthesia-related problems Sometimes it becomes necessary during the procedure to abandon the robotic method and perform the surgery using traditional methods (eg, traditional laparoscopic or open surgery) Average Hospital StayUsually 1-2 days, but may be longer, depending on the procedure.

Postoperative Care You will receive instructions on when and what you can eat, and how you need to restrict your activity. Your doctor will likely advise you to: Take antibiotics to help prevent infectionAvoid certain medicationsDrink plenty of fluids to clear your bladderEat a high-fiber diet, drink plenty of water, and use stool softeners if necessary to avoid constipationAvoid caffeinated beverages, alcohol, spicy foods, or other food or drink that might upset your stomach, intestines, or urinary tractKeep legs elevated and moving to avoid blood clotsResume normal activities (eg, taking daily walks) soon, to promote healingLimit certain activities, such as driving, walking up stairs, lifting, working, and engaging in sexual intercourse, for a period of timeAvoid tub baths during the first two weeks after surgeryWash the incisions with mild soap and water OutcomeDepending on your procedure, you should be able to resume most regular activities within 3-6 weeks after your procedure. Based on evidence available to date, the risks of robotic surgery appear to be less than for more traditional forms of surgery. Benefits of robot-assisted urologic procedures over traditional ones may include: Reduced trauma to the bodyReduced risk of blood transfusionShorter hospital stayFaster recovery Call Your Doctor If Any of the Following Occurs It is essential for you to carefully monitor your own recovery once you leave the hospital. That way, you can alert your doctor to any problems immediately. Promptly notify your doctor if any of the following occur:

Catheter stops draining or falls out (if you had a catheter placed)Signs of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from an incision siteAbdominal swelling or painConstipationCough, shortness of breath, chest pain, or severe nausea or vomitingDifficulty urinating, such as pain, burning, urgency, or frequencyHeavy bleeding or clots in the urinePain and/or swelling in your feet, calves, or legs, or sudden shortness of breath or chest painNausea, vomiting, and/or diarrheaHeadache, muscle aches, feeling faint or dizzyOther worrisome symptoms RESOURCES: American Urological Associationhttp://urologyhealth.org National Kidney and Urologic Diseases Information Clearinghousehttp://kidney.niddk.nih.gov CANADIAN RESOURCES: Canadian Urological Associationhttp://www.cua.org The Kidney Foundation of Canadahttp://www.kidney.ab.ca References: Bladder cancerrobot-assisted laparoscopic radical or simple cystectomy. University of Chicago website. Available at: http://www.ucurology.org/homeThumbs/laproscopicB6.htm . Accessed July 8, 2006. Complete Guide to Symptoms, Illness & Surgery. Putnam Publishing Group; 2000. Megaureter. Childrens Hospital Boston website. Available at: http://www.childrenshospital.org/az/Site1288/mainpageS1288P0.html . Accessed July 8, 2006.

Minimally invasive surgery laparoscopic surgery. Emory Healthcare website. Available at: http://www.emoryhealthcare.org/departments/urology/sub_menu/laparoscopic.html . Accessed July 8, 2006. Robot-assisted laparoscopic radical prostatectomy. Johns Hopkins Medicine website. Available at: http://urology.jhu.edu/MIS/roboticRRP.php. Accessed July 8, 2006. Robotic dismembered pyeloplasty. Cleveland Clinic website. Available at: http://cms.clevelandclinic.org/urology/body.cfm?id=221 . Accessed July 8, 2006. Last reviewed April 2008 by Rosalyn Carson-DeWitt, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.