Robotic surgery

BREAKTHROUGH OF ROBOTICS IN UROLOGIC SURGERY

With the arrival of Dr. Mottrie (Fellow at the Washington University of St.-Louis, Missouri, U.S.A.) the Onze-Lieve-Vrouw Hospital in Aalst became one of the first hospitals in the world (2001) to place robotic surgery on the map in Europe.

This provides very extensive expertise with robotics in urologic surgery.

Royal Doctors: How and why did you start with this revolutionary technique?

After the breakthrough in laparoscopic surgery in the nineties, the use of a robot is possibly the next step on the road to ever more precise and less traumatising surgery. Especially urology seems to benefit from this new technique. We raised this subject with Alex Mottrie, urologist at the OLV Hospital in Aalst and for several years an authority in the area of ‘robotic surgery’.

The medical equipment for robotic surgery was introduced to our hospital initially for

heart surgery, but soon it became clear that this technique could also be used for urologic surgery and that the robot could be a very advantageous tool for specific indications as it enables us to do an ultraprecise, almost microsurgical handling through keyhole surgery without having to open the patient. For about nine years I have focussed on this method and could treat over 1,500 patients with it to date. The results are particularly positive and encourage us to make it better known and promote this approach among urologist colleagues.

Royal Doctors: Which advantages offers this technique?

The use of robotics signifies a great leap forward. In classic laparoscopy the operating field is magnified by a camera with video techniques but this is invariably followed on a television screen which unfortunately does not provide depth perception. With robot surgery the surgeon not only benefits from a magnifying effect but also over an excellent three-dimensional image thanks to the dual lens integrated in the optics. With a better view, better operations.

Furthermore, during classic laparoscopy long and stiff instruments are used which often cause awkward movements, e.g. an upward movement of the hand can cause a downward movement of the instrument in the abdominal cavity. This not only hinders the learning process, but certainly limits the precision of movements.

Robotic surgery is remote surgery during which the urologist controls the instruments in the abdominal cavity from the workstation (“console”) via levers with which he makes virtual movements in space. The movements are transmitted via computer to the robotic arms in the abdominal cavity which reproduce the movements exactly – the movements are however reduced to a scale of 5 and therefore much more precise. The robotic instruments also have fine joints at their extremities, thus increasing the mobility of the instruments tips und permitting to execute natural movements in miniature. The robot actually reduces the surgeon’s manipulations, which simplifies micro-dissections and –sutures.

Royal Doctors: For which urologic surgeries are they mostly indicated?

Doubtless there are a number of operations which can best be performed with the assistance of robotics, mainly reconstructive surgery and surgery requiring extremely accurate operations, e.g. partial nephrectomy (kidney-sparing surgery in case of kidney tumours), cystectomy (removal of the bladder), pyeloplasty, ureter re-implantation or end-to-end-anastomosis after vasectomy (surgical repair after a previous sterilisation).

Expressed in absolute figures, the most important indication is the prostate cancer operation (radical prostatectomy). A significant problem with this operation is the risk of incontinence and erectile dysfunction. This can be avoided by careful extirpation of the prostate from the pericapsular tissues containing the nerves responsible for erections and the locking mechanism. Particularly in this area the use of robotics can offer enormous advantages.

Obviously this is only possible if a nerve-sparing technique is oncologically justified.

As to kidney tumours, we have developed a technique with which the tumour can be safely removed by means of robotic surgery without having to sacrifice the whole kidney and, moreover, without painful cuts!