Robotic surgery in bladder cancer
Bladder cancer is the sixth most common cancer in the United States, where 65,000 people receive this diagnosis every year. Although the incidence of bladder cancer continues to rise, survival rates are also improving thanks to the application of advanced treatment methods.
The treatment of bladder cancer varies according to the stage of the disease. However, whether it is detected at a superficial stage or has invaded the muscle layer of the bladder, a radical approach is applied in the treatment of large tumours made up of aggressive cancer cells. This procedure, in which the bladder is removed entirely, is called "radical cystectomy".
Radical cystectomy is performed with the Da Vinci robot without opening the body. If the severity of the bladder cancer allows, the nerves responsible for sexual function can be preserved during this procedure, which is carried out without visible bleeding or loss of fluids and electrolytes.
The advantages of radical cystectomy performed with the Da Vinci robotic system
- Enhanced three-dimensional vision and 10 to 20 times magnification.
- No loss of fluids, heat and electrolytes thanks to a smaller incision in the abdominal wall
- Preservation of the nerves of sexual function
- Reduced bleeding
- Markedly less pain after the procedure
- A better cosmetic result thanks to the small incision
- Faster recovery and a reduced risk of complications thanks to the absence of loss of fluids, heat, blood and electrolytes, unlike open surgery.
Pyeloplasty – Robotic surgery for pelviureteric junction obstruction
Obstruction of the ureter (pelviureteric junction obstruction) has various causes. It may result from an internal obstacle at the point where the renal pelvis passes into the ureter, or from compression by a blood vessel coming from the lower part of the kidney, which is not normally present at that point. Whatever the cause, such an obstruction of the flow of urine from the kidney must be treated surgically. This surgical procedure, called "pyeloplasty", gives favourable results with the Da Vinci robot. The abdominal cavity is accessed through small incisions, without requiring numerous sutures or knots. In addition, micro-instruments with a greater range of movement, combined with 12 times magnification and three-dimensional vision, help to increase the success rate.
The advantages of Da Vinci robotic pyeloplasty
- Less pain after the procedure
- Reduced blood loss
- Surgery under magnified and widened vision
- The advantage of three-dimensional depth
- Millimetre-precise suturing comfort on all sides, thanks to small robotic arms that eliminate tremor and offer 540-degree wrist movement
- A shorter hospital stay
- A faster return to the normal activities of daily life
- A higher success rate than with open and laparoscopic surgery
- A better cosmetic result compared with open surgery
Robotic surgery in prostate cancer
Prostate cancer is of particular importance, as it is the most common cancer in men after skin cancer. It is also the second leading cause of cancer death in men.
In the treatment of prostate cancer, among the options of drug treatment, radiotherapy and surgery, radical prostatectomy has become the most frequently performed procedure because of its favourable results. During this procedure, the prostate tissue and the seminal vesicles are removed entirely; in high-risk patients, the lymph nodes near the prostate may also be removed.
Whereas conventional surgery requires a large incision, Da Vinci robotic surgery makes it possible to access the abdominal cavity through a small incision. The advantages of Da Vinci robotic surgery — 12 times magnification of the operating field and three-dimensional vision, as well as the use of micro-instruments with a wide range of movement — make it possible to achieve an excellent surgical result in preserving the nerves responsible for urinary control and the sphincter muscles, and better preservation of the nerve bundles responsible for sexual function. This is of particular importance for patients who are keen to preserve their sex life.
If the patient is under 60 and a bilateral nerve-sparing procedure is applied, the ability to maintain sexual function without medication after radical prostatectomy by Da Vinci robotic surgery is about 80 to 90%, and normal urinary continence 96 to 98%.
Above all, however, the Da Vinci robotic surgery system does not rely solely on the capabilities of the robot; the experience of the surgeon who will perform the procedure is also decisive in radical prostatectomy. That is why surgical experience must be taken into account.
The advantages of robotic radical prostatectomy
- Less blood loss
- In robotic radical prostatectomy procedures, the operating field can be magnified thanks to high-resolution three-dimensional cameras. The enhanced vision thus makes it possible to stop bleeding more quickly. In addition, insufflating gas into the abdomen also reduces bleeding.
- A reduced length of hospital stay
- As robotic surgery procedures require smaller incisions, the length of hospital stay is reduced compared with open surgery. In addition, thanks to reduced blood loss, the patient goes home sooner.
- Less pain
- As the incisions are smaller, post-operative pain is reduced.
- Better control of the cancer
- Instruments designed with high-resolution three-dimensional vision and 7 degrees of freedom allow the surgeon to see better and to remove the cancerous tissue of the prostate.
Robotic surgery in kidney cancer
Kidney cancers fall into two groups according to their location: cancers of the parenchyma (the region where urine is produced) and cancers of the collecting system (the place where urine is collected). Cancers of the renal parenchyma account for 3% of all cancers in adults. They are more common in men; they are seen more often in people with congenital kidney diseases and certain systemic diseases. They are also said to be more common in people with kidney failure.
Complete surgical removal of the cancerous tissue is the main treatment for kidney cancer. However, the success of complete surgical treatment depends above all on the stage and grade of the cancer. Early detection and treatment of kidney cancer increase the chances of cure.
The surgical treatment of kidney cancer depends on the size and location of the tumour. If the surrounding fatty tissue and the adrenal gland are removed together with the whole kidney, the procedure is called radical nephrectomy; if only the tumour-bearing part is removed, it is called partial nephrectomy.
Da Vinci robotic surgery can be used successfully in these procedures; it shows an advantage over open or laparoscopic surgery, particularly in partial nephrectomy. Partial nephrectomy is the flagship of urological surgery in which robotic surgery is applied, after radical prostatectomy.
Small incisions are made in the abdominal cavity during procedures that use three-dimensional vision magnified 12 times. The use of micro-instruments with a wide range of movement also offers an advantage over open or laparoscopic surgery.
Whereas nephrectomy lasts 1.5 to 2 hours, this time can be reduced to 45 minutes, particularly in simple nephrectomy. Even in the presence of large tumours, the patient generally goes home on the first or second day after the procedure.
The benefits of the Da Vinci procedure for the patient in kidney tumours
- Less pain
- Reduced blood loss
- A reduced length of hospital stay
- Tremor-free robotic arms
- A faster return to the normal activities of daily life
- More delicate surgery
- A successful procedure against cancer
Other urological surgical procedures
- Da Vinci ureteral reimplantation (in obstruction of the junction of the ureter with the bladder)
- Da Vinci pyelolithotomy (removal of stones from the renal pelvis)
- Da Vinci bladder diverticulectomy (in bladder diverticulum)
- Da Vinci adrenalectomy (in diseases of the adrenal glands)
İlker Tinay
İlker Tinay
Education and experience
- Istanbul University, Istanbul Faculty of Medicine
- Urology, Marmara University Faculty of Medicine
Affiliations
- Member of the board of the Society of Uro-Oncology
- Secretary of the bladder tumour research group of the Society of Uro-Oncology
- Member of the board of the North Marmara section of the Society of Urological Surgery
- International Bladder Cancer Network
- Member of the European Association of Urology
- Member of the American College of Surgeons
Research and publications
- Marmara University Faculty of Medicine, Scientific Encouragement Award for interns, 2008
- National Congress of Urological Surgery, Young Academic Presentation Award, 2012
- Scientific Research Award of the Society of Uro-Oncology, 2019