Majority of surgeries in uro oncology – Radical Prostatectomy , Partial Nephrectomy , Radical Cystectomy , Nephro uretrectomy – are done robotically worldwide. However there are many myths prevalent regarding robotic surgery. We are highlighting some of them here:
It is the surgeon who does the surgery by operating the robot to perform precise surgical steps. The robot does not and cannot independently perform any surgical step. The surgeon’s finger movements on the console are transmitted to the robotic arms to the patient. In fact the robot filters a surgeons tremors in the fingers during surgery to make the surgery more precise.
The surgeons training and experience in laparoscopic and open surgery , along with the understanding of the anatomy are vitally important in the success of robotic surgery . A robotic surgeon has to undergo rigorous , supervised and extensive training before he starts operating. An inexperienced surgeon cannot make the surgery better just because he has the robot. It is always prudent to select the right surgeon and the right technology.
Robotic surgery is expensive as compared to open or laparoscopy in the short term . However the long term costs are not that different if we consider the cost of prolonged recovery, delayed return to work , requirement in terms of manpower and finances during this recovery period.
The surgical robot is controlled by a human hand. It is as prone to complications as any other technique , however the incidence and magnitude of these complications appear to be lower with robotic surgery . Patients recover faster after the operation in robotic surgery as compared to open surgery.
Depending on the stage of the disease, the patient may require radiation , chemotherapy or hormonal therapy after robotic surgery is done . This additional treatment can be given faster after robotic surgery because the patients recovery in terms of urinary control and wound healing is faster.
While cancer control might be similar in prostate, kidney and bladder cancer surgeries, the functional outcomes in terms of urinary control, wound healing and kidney function recovery are far superior in the peri operative period for robotic surgery.
The main advantages of robotic surgery are – less blood loss , less pain , early discharge , early urinary control. Improved cosmesis is the least important of all advantages.
All surgeons are used to operating with a feel of the tissues by tactile or haptic feedback during open or laparoscopic surgeries. This tactile feedback is not possible in robotic surgery. However, the visual cues of offered in robotic surgery by superior 3D vision, and upto ten times magnification of the operative field, makes the surgery much easier. The surgeon operates sitting on a console in a relaxed ergonomic fashion which reduces surgeon fatigue in long surgeries.
Robotics has the advantage of ease of ergonomic motion, easy suturing, better optics including 3D vision and camera controlled by surgeon, 7 degrees of freedom of movements for the instruments and shorter learning curve as compared to laparoscopy. Since it is easier to learn than laparoscopy, large volumes of surgery are not needed to achieve good outcomes.
In case of such malfunctions, there is a fool proof and recoverable system where each fault can be rectified safely.