Robotics and urologic reconstructive surgery

Abstract

Minimally invasive surgery has made a profound impact on how urologists approach the challenges in reconstruction of the urinary tract. The advent of laparoscopic approaches to reconstructive urology have demonstrated comparable outcomes to open surgery with improved morbidity. The recent adoption of robotic surgery has seen further advancements such as improved visibility and, freedom of movement, and an easier technical learning curve. With these advantages, more reconstructive urology procedures are being performed robotically. Herein, we review reconstructive urology procedures for which robotics have been applied.

Can Computerized Simulation be Used to Assess Surgical Proficiency in Laparoscopic Colorectal Surgeries? A Systematic Review

“…43 In CRS, additional advantages of robotic surgery include the ability for easier maneuverability within the narrow pelvis for low rectal surgery for precise dissection and intracorporeal suturing and reconstruction. 44 VR simulators for robotic surgery are already available commercially, such as the Da Vinci skills simulator (dVSS) (Intuitive Surgical, Sunnyvale, United States), or the Mimic dVTrainer (Dv-Trainer) (Mimic Technologies, Inc, Seattle, United States). 45 These simulators allow the surgeon to practice general robotic skills such as control of the camera, clutch, energy pedal and wrist articulation.…”

The application of the “omental wrapping” technique with autologous onlay flap/graft ureteroplasty for the management of long ureteral strictures

“…Due to the concerns with these existing procedures, the onlay repair technique has started to emerge and has already produced encouraging outcomes (6)(7)(8). Successful ureteral repair surgery relies on tension-free and watertight reconstruction with important principles, including minimization of ureteral manipulation and preservation of ureteral blood supply (17). One of the most attractive advantages of the onlay repair technique is that it makes full use of the ureteral stricture to become a "ureteral plate" without increasing tension.…”

Robotic assisted reconstruction for complications following urologic oncologic procedures

“…Robotic bladder neck reconstruction (RBNR) holds several advantages over open pelvic reconstruction, including increased articulation in a narrow working space, optimized visualization allowing precise suturing and decreased tremors. Typically, if the level of obstruction does not extend beyond that of the urogenital diaphragm, a perineal counter incision for urethral mobilization is unnecessary (7). Several groups have reported Y-V plasty outcomes in which the scar is incised on the anterior surface and a flap of bladder is advanced distally to increase the lumen diameter (8).…”

“…Trans-abdominal repair was required in only 20% of cases. Evidence for robotic transperitoneal RUF is limited to case reports (7,(13)(14)(15). All 4 reported successful fistula repair with multi-layer closure plus tissue interposition (2/4) or temporary bowel diversion (1/4).…”