The age of robotic surgery – Is laparoscopy dead?

Abstract

IntroductionRobot-assisted laparoscopic surgery (RALS) has become a widely used technology in urology. Urological procedures that are now being routinely performed robotically are: radical prostatectomy (RP), radical cystectomy (RC), renal procedures – mainly partial nephrectomy (PN), and pyeloplasty, as well as ureteric re-implantation and adrenalectomy.MethodsThis non-systematic review of the literature examines the effectiveness of RALS compared with conventional laparoscopic surgery for the most relevant urological procedures.ResultsFor robot-assisted RP there seems to be an advantage in terms of continence and potency over laparoscopy. Robot-assisted RC seems equal in terms of oncological outcome but with lower complication rates; however, the effect of intracorporeal urinary diversion has hardly been examined. Robotic PN has proven safe and is most likely superior to conventional laparoscopy, whereas there does not seem to be a real advantage for the robot in radical nephrectomy. For reconstructive procedures, e.g. pyeloplasty and ureteric re-implantation, there seems to be advantages in terms of operating time.ConclusionsWe found substantial, albeit mostly low-quality evidence, that robotic operations can have better outcomes than procedures performed laparoscopically. However, in light of the significant costs and because high-quality data from prospective randomised trials are still missing, conventional urological laparoscopy is certainly not ‘dead’ yet.

Role of laparoscopy in the era of robotic surgery in urology in developing countries

“…RAUR has also been attempted for pediatric VUR; however, no consensus currently exists and RAUR has been found to have higher complication rates and lower success rates than the open approach in some reports. [ 68 ]…”

Minimally invasive ileal ureter replacement: Comparative analysis of robot‐assisted laparoscopic versus conventional laparoscopic surgery

“…According to a non‐systematic review by Schwaibold et al. , 4 there was high‐quality evidence that the robot‐assisted technique has better efficacy in terms of radical prostatectomy and partial nephrectomy, where the robot could replace conventional laparoscopy. As for reconstructive surgery, such as pyeloplasty and ureteral replantation, there appears to be an advantage in terms of surgical time.…”

“…Currently, besides the obvious aesthetic advantages, the laparoscopic ileal ureter replacement technique also offers more recovery advantages than the traditional open repair technique 3 . It has also been reported that robot‐assisted laparoscopic surgery (RALS) is as safe as open surgery, and it is superior to open techniques with respect to intraoperative estimated blood loss (EBL) and postoperative recovery in a variety of reconstructive urological procedures 4 . However, there have only been a few reports with a limited number of ileal ureter cases 5,6 …”

“…robot-assisted laparoscopic surgery (RALS) is as safe as open surgery, and it is superior to open techniques with respect to intraoperative estimated blood loss (EBL) and postoperative recovery in a variety of reconstructive urological procedures. 4 However, there have only been a few reports with a limited number of ileal ureter cases. 5,6 To date, there have been no comparative analyses between different minimally invasive techniques.…”

Establishing changes in endotracheal cuff pressure with continuous monitoring in patients undergoing laparoscopic surgery in Trende- lenburg position

“…Besides, with more and more surgical procedures being performed with a laparoscopic technique nowadays, patients are frequently placed in a Trendelenburg position in combination with the establishment of a pneumoperitoneum (4,5). This results in an increased airway and endotracheal cuff pressure (4).…”