Robot-assisted microsurgery for chronic orchialgia

Abstract

Chronic orchialgia is one of the most common complaints seen in the urologists office and has traditionally been considered a very difficult diagnostic and therapeutic challenge for the clinician. First line management of chronic orchialgia is conservative treatment; however, in men who fail conservative therapy, surgical intervention may be indicated. Microsurgery has been the mainstay for surgical treatment of chronic orchialgia, but the implementation of robotics to microsurgery lends itself particularly to surgical treatment of chronic orchialgia. PubMed was used to perform a current literature search on chronic orchialgia with robotic microsurgery, robotic spermatic cord denervation, robotic varicocelectomy, and robotic vasectomy reversal. Although conservative therapy is considered the first line treatment for chronic orchialgia, reported outcomes are moderate to poor, with the need to proceed to surgical intervention in select cases. Current surgical therapies in which robot assistance have been applied to microsurgery include microsurgical denervation of the spermatic cord, varicocelectomy, and vasectomy reversal. As further studies have assisted in the understanding of surgical treatment of chronic orchialgia, the application of robot assistance to this level of microsurgery has been shown to be feasible and safe with comparable outcomes to traditional microsurgery and may provide potential advantages.

Use of optical magnification and microsurgical technique in general surgery

“…28 In a recent review Korzadeh reported that inguinal hernia repair with use of mesh in bilateral open and/or laparoscopic repair may cause male infertility for the obstruction and/or damage to the cord and the vessels. 29 It is quite innovative that, a recent article proposes the use of an operating microscope in the treatment of inguinal hernia, especially when employed by an urologist performing simultaneous operations for varicocele or surgical procedures on spermatic cord or testis.…”

Robotics in urology

“…74 Others have used the magnified 3D view that the robotic system offers to perform a variety of microsurgical procedures, including varicocelectomy, vasectomy reversal, spermatic cord denervation and testicular sperm extraction. 75 So far these have not exhibited superiority over the use of an operating microscope to justify the high cost.…”

Vasovasostomy and vasoepididymostomy: Review of the procedures, outcomes, and predictors of patency and pregnancy over the last decade

“…One study reported that the group tried to come to an understanding with its community‐based hospital to use the robot in slots when there was less use, such as early morning and late afternoon. It was argued that the average per‐case added cost was reduced when more patients underwent robotic surgery …”

“…It was argued that the average per-case added cost was reduced when more patients underwent robotic surgery. 66 As…”