Robot-assisted surgery proved to be a more efficient and safer treatment option for patients who suffered from kidney blockages which prevent urine from draining normally to the bladder, according to a study published in the Canadian Journal of Urology.
The study looked at 60 patients who had a procedure known as pyeloplasty that involves reconstructing the narrow area where part of the kidney meets the ureter, the tube that carries the urine from the renal pelvis into the bladder.
Ashok Hemal, MD, a urologic surgeon from Wake Forest University Baptist Medical Center (Winston Salem, North Carolina), compared both laparoscopic procedures and robot-assisted surgery using the daVinci surgical system developed by Intuitive Surgical (Sunnyvale, California) for repairing the blockage.
"What we found was that for patient's that underwent the robotic assistance the hospital stays were shorter, and recovery periods were much faster," Hemal told Medical Device Daily.
Hemal said that following the patients for 18 months showed that both options were equally successful, but the robot-assisted technique had several advantages.
The first advantage was the time it took for the procedure to be completed.
In the study, procedures using the robotic assistance tool were done within 98 minutes with blood loss of about 40ml. The laparascopic procedure took 145 minutes with an estimated blood loss of 101 ml.
But Hemal said perhaps the biggest advantage for surgeons is the relative ease of the robot-assisted procedure.
"The number one advantage for this procedure is that the learning curve is very small for surgeons," Hemal told MDD. "It's also faster and more efficient to use."
According to Hemal's report, the robotic pyeloplasty was performed using a transperitoneal transmesocolic approach on the left side and via retrocolic access on the right side by reflecting the ascending colon. Robotic pyeloplasty was performed through 4 ports. A 12 mm port was placed at the umbilicus or periumbilically for the stereoscopic robotic camera, and two 8 mm robotic ports were placed in the midclavicular line. A 5 mm trocar port for retraction, suction, and suture cutting was placed infra-umbilically in the midline or on the contralateral side.
The type of repair depended on the size of the pelvis, length of the UP structure, presence of a crossing vessel, and the degree of renal function.
Robotic assistance was used from the outset to dissect and mobilize the colon, ureter, and renal pelvis. It was also used for reconstruction of the flaps, for neo-UPJ anastomoses, and for antegrade double-J stenting.
In one case, a retrograde stent was placed beforehand, and in three cases, anastomosis was done without a stent. A drainage tube was placed in all cases prior to port closure.
Hemal added that the 3-dimensional view the daVinci surgical system gives the user is more accurate and precise which is one of the reasons the robot-assisted technique yielded far greater results.
"It gives you a depth perception that you were unable to have in previous techniques," Hemdal said. "That's what makes the procedure easier to use."
Researchers in the study are saying this is one of the first in which a surgeon with expertise in both options compared the two procedures.
Previously the repair required a large incision. New technology led to minimally invasive approaches that require only small incisions laparoscopic surgery, in which the surgeon directly manipulates a viewing device and operating instruments inserted into the abdomen, and robot-assisted surgery, in which the surgeon sits at a console and uses hand and finger movements to control centimeter-size instruments while viewing the surgical site on a screen.
"There are no real disadvantages to using the daVinci," Hemal told MDD. "The robot is expensive, that might be a disadvantage. But for the most part this is a very beneficial procedure for patients."
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