Da Vinci Robotic Surgery

What Is Robotic Surgery?

Da Vinci robotic surgery, also simply called robotic surgery, is the most advanced technology surgery has reached in today's medicine, standing out for the particular advantages it offers both the doctor and the patient.

In this system, the imaging works on the principle of laparoscopic surgery; that is, images from inside the patient's body are transmitted to the surgeon via a camera. Unlike laparoscopic surgery, in robotic surgery this image is three-dimensional and, because the camera is controlled by the robot, it is a clear, tremor-free image. By moving very close to the organ being operated on, clear images can be obtained at higher magnification.

The surgeon controls the robotic arms from a console. These robotic arms are positioned on the patient. Fiber-optic cables in the console run to the robot's arms and transfer the surgeon's small hand movements to the robotic arms, enabling the attached instruments, such as surgical scissors, tissue graspers or needle holders, to perform the desired movements. Because the surgical instruments attached to the robotic arms can rotate 540 degrees, they can move in ways that go far beyond the range of hand movements. In addition, the natural tremor of the human hand is not transmitted at all to the tips of the surgical instruments in robotic surgery. This keeps the margin of error to a minimum.

Robotic surgery was first used in 1994, and its most common area of use has been urological surgery. Since 2001, the da Vinci system has been used worldwide most often in prostate cancer surgery; it is also used for kidney, bladder and testicular cancers.

Advantages of robotic surgery for the patient in prostate surgery:

Patients who undergo robotic surgery stay in the hospital for a shorter time than other patients and are discharged earlier. This is because the incisions are smaller in robotic surgery, blood loss is lower and patients feel less pain after surgery.
In patients who undergo radical prostatectomy with the robotic method, the catheter is removed earlier; that is, they spend less time with a catheter. This is because in robotic prostatectomy the bladder and the external urinary channel called the urethra can be sutured together better and in a watertight way. The catheter is usually removed after 7 days.
Patients who undergo robotic surgery feel less pain after surgery and need fewer painkillers. This is because the incisions are smaller than in open surgery, so they feel less pain.
Cancer control is achieved better in robotic surgery. With a camera system offering three-dimensional, high-resolution images and robotic arms with 7 degrees of freedom able to move 540 degrees in every direction, cancerous tissue is seen and removed more clearly during surgery.
After prostate surgery with robotic surgery, urinary control is better and returns sooner. Better visualization, less bleeding and better suturing of the bladder to the urinary channel allow urinary control to return more quickly after surgery.
After prostate cancer surgery performed robotically, an earlier return to sexual activity is seen. In medically suitable patients, preservation of the nerve and vessel bundles around the prostate that are responsible for erection is achieved more precisely with robotic surgery. For this reason, these patients return to sexual activity earlier after surgery.

Advantages of robotic surgery for the patient in kidney tumors:

In kidney tumor surgery performed robotically, effective cancer control is the aim. In suitable cases, only the tumor tissue is removed and the healthy kidney is preserved. With robotic technology, under a three-dimensional, high-resolution magnified view, the depth of the tumor within the tissue can easily be assessed and the tumor is removed from the kidney. After the tumorous tissue is removed, the resulting tissue defect, opened vessels and injured urinary channels are repaired delicately and quickly using the robotic arms. In large kidney cancers, it can also be used to remove the kidney.

After surgery, just as in prostate cancer, robotic surgery in kidney tumors preserves cosmetic appearance and provides a fast and comfortable recovery, with less pain and a quicker return to daily activities.

In urology, in addition to prostate cancer and kidney tumors, many operations such as bladder cancer, ureteral stricture, incontinence surgery and ureteropelvic junction (UPJ) obstruction can be performed with robotic surgery today.

LAPAROSCOPIC SURGERY

Laparoscopy is a surgical technique for treating abdominal organs in which, instead of large incisions, surgery is performed with long, thin instruments passed through small tubes inserted via 3 or 4 small (0.5–1 cm) openings.

At the start of the procedure, the abdomen is inflated with carbon dioxide gas to give the surgeon working and viewing space. Images from the abdominal cavity are projected onto a screen with a high-resolution camera system, and the surgery is performed with an image of the organ magnified approximately 10–15 times. This system allows the surgeon to carry out the same procedures as in traditional open surgery through much smaller incisions.

Areas Where Laparoscopic Surgery Is Used in Urology:

Kidney cancer: laparoscopic radical and partial nephrectomy
Prostate cancer: laparoscopic radical prostatectomy
Bladder cancer: laparoscopic radical cystectomy
Adrenal gland tumors: laparoscopic adrenalectomy
Testicular cancer: laparoscopic RPLND
Undescended testicle: laparoscopic orchiopexy
Ureteropelvic junction (UPJ) obstruction: laparoscopic pyeloplasty
Kidney removal: laparoscopic nephrectomy
Advantages of Laparoscopic Surgery Over Open Surgery:

Cosmetically, very small scars instead of one large incision
Less pain and less bleeding after surgery
Shorter hospital stay
Faster return to daily life
Surgery performed with large, HD image quality
A significant cost advantage compared with robotic surgery