When patients hear they should have robotic surgery for urological problems, some experience a fear of machines. Others mistakenly think nothing can go wrong. A few even believe — perhaps based on watching a few too many episodes of “Dr. Who” — that the robot will be making moves on its own, outside of the surgeon’s direct control.
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All of those notions are myths, according to urologist Jihad Kaouk, MD, Director of Cleveland Clinic’s Center of Advanced Laparoscopic and Robotic Surgery.
“All moves of robotic instruments are following the hand of the surgeon controlling the joystick,” Dr. Kaouk says. “Although the robot is an excellent tool, it comes down to the surgeon’s experience to conduct a successful surgery.”
Another myth is that the robot will do surgery and nothing can go wrong. In reality, robotic surgery is just another laparoscopic tool that allows for minimally invasive surgery, experts say.
Why do surgeons use a robot?
Urology — as well as gynecology and colorectal specialties — use the robot because it can help visualize the small areas. Working alongside a robot provides three arms and a camera completely under the surgeon’s control.
Also, the technique of surgery is the same, and there are similar numbers of incisions. What some surgeons like is that it can make it easier to perform the surgery and to be more precise.
The first and most common robotic procedure for urologists is for prostate cancer, Dr. Kaouk says. It limits blood loss and incision pain and it has a lower learning curve with similarly good results.
But with these benefits comes another myth: “The myth is that the robot will totally avoid the risk of impotence after surgery,” Dr. Kaouk says. The known risks of any surgery apply, whether performed with a robot or not.
Robotic surgery beyond experimental phase
What’s true is that patients benefit from “a minimally invasive procedure, quicker recovery and less blood loss especially for challenging cases, such as obese patients or patients with previous abdominal surgery or radiation.”
Robotic surgery on the kidneys is now beyond the experimental phase and has become the standard of care, Dr. Kaouk says.
Robots allow surgeons to work in various places deep within the body, “where open surgery would be difficult to do and would require a large cut through the patient’s muscle and abdominal wall,” he says.
“For example, when the bladder is removed, urine has to be diverted. To do that, we borrow a piece of bowel to form a new bladder, or conduit to the outside. We used to do that with a big cut to do the bowel work outside the body, but in the most recent advancement, we can do the entire surgery inside the body.”
That doesn’t mean the surgery is easy or straightforward, Dr. Kaouk says.
“We are able to improve outcomes and cut surgery time significantly,” he says. “It still requires a lot of experience and time to do such procedures.”