Robotic Surgery in Urology



Robotic-assited laparoscopic surgery, seems to be an exciting and new emerging frontier even in the field of urology, has large potential benefits to progress in the future. Nguen and Das (Urol Clin North Am 31(4):653–658, 2004) and Long et al. (Prog Urol 16(1):3–11, 2006) well reviewed these potential benefits in urologic surgery and its future progress. It is important that urologists should keep interest of the new technologies and understand their limitations and the possibility of incorporating them in day-to-day surgery. Advanced robotic surgery was first introduced into urology in 2000. The early studies showed the feasibility and safety of the da Vinci (Intuitive Surgical Inc., Sunnyvale, CA) telemanipulator assistance in radical prostatectomy (Coelho et al., J Endourol 24:2003–2015, 2010; Menon and Hemal, J Endourol 18:611–619, 2004; Menon et al., Eur Urol 58:838–846, 2010; Menon et al., Eur Urol 51:648–657, 2007; Patel et al., BJU Int 106:696–702, 2010; Coelho et al., Eur Urol 57:945–952, 2010; Menon et al., J Urol 168(3):945–949, 2002), and the technique extended to pyelo-ureteric junction obstruction (Gupta et al., BJU Int 105:980–983, 2010; Gettman et al., Eur Urol 42:453–457, 2002; Hemal et al., Can J Urol 17:5012–5016, 2010; Nayyar et al., World J Urol 28:599–602, 2010; Gupta et al., J Endourol 23:945–948, 2009), radical cystectomy (Richards et al., Urology 76:1400–1404, 2010; Hemal et al., Urol Clin North Am 31:719–729, 2004; Menon et al., J Am Coll Surg 198:386–393, 2004; Menon et al., BJU Int 92:232–236, 2003; Pruthi et al., J Urol 183:510–514, 2010; Nix et al., Eur Urol 57:196–201, 2010), and partial nephrectomy (Gettman et al., Urology 64:914–918, 2004; Benway et al, J Urol 182:866–872, 2009; Wang and Bhayani, Urology 73:306–310, 2009; Scoll et al., Urology 75:1328–1334, 2010). The miniature endowristed tools offer a potential advantage over standard laparoscopy in the accuracy of preparation and suturing. Other advantages are a three-dimensional vision system and unimpaired hand-eye coordination. Complex laparoscopic tasks are learned faster by using the robot, which may also explain the shorter learning curves required for radical prostatectomy than for traditional laparoscopic procedure. This new technology has spread rapidly over the past 15 years. By 2006, approximately 60 % of radical prostatectomies in the USA was robot-assisted. Data on the functional and oncological outcomes are accruing but not yet conclusive. Therefore, controlled clinical trials and comparisons from various centers are further needed. Other important concerns are the cost and training implications. Future application may also allow integration of pre- and intraoperative imaging in the management of urological diseases. In the not too distant future, newer robotic instruments will be added to the armamentarium for performing different surgical procedures in urologic diseases.


Radical Prostatectomy Partial Nephrectomy Radical Cystectomy Localize Prostate Cancer Positive Surgical Margin 
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Estimate blood loss


Positive surgical margin


Standard deviation


  1. 1.
    Nguen MM, Das S (2004) The evolution of robotic urologic surgery. Urol Clin North Am 31(4):653–658CrossRefGoogle Scholar
  2. 2.
    Long JA et al (2006) Use of robotics in laparoscopic urological surgery: state of the art. Prog Urol 16(1):3–11PubMedGoogle Scholar
  3. 3.
    Coelho RF, Rocco B, Patel MB, Orvieto MA, Chauhan S, Ficarra V et al (2010) Retropubic, laparoscopic, and robot-assisted radical prostatectomy: a critical review of outcomes reported by high-volume centers. J Endourol 24:2003–2015PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Menon M, Hemal AK (2004) Vattikuti institute prostatectomy: a technique of robotic radical prostatectomy: experience in more than 1000 cases. J Endourol 18:611–619PubMedCrossRefGoogle Scholar
  5. 5.
    Menon M, Bhandari M, Gupta N, Lane Z, Peabody JO, Rogers CG et al (2010) Biochemical recurrence following robot-assisted radical prostatectomy: analysis of 1384 patients with a median 5-year follow-up. Eur Urol 58:838–846PubMedCrossRefGoogle Scholar
  6. 6.
    Menon M, Shrivastava A, Kaul S, Badani KK, Fumo M, Bhandari M et al (2007) Vattikuti institute prostatectomy: contemporary technique and analysis of results. Eur Urol 51:648–657PubMedCrossRefGoogle Scholar
  7. 7.
    Patel VR, Coelho RF, Chauhan S, Orvieto MA, Palmer KJ, Rocco B et al (2010) Continence, potency and oncological outcomes after robotic-assisted radical prostatectomy: early trifecta results of a high-volume surgeon. BJU Int 106:696–702PubMedCrossRefGoogle Scholar
  8. 8.
    Coelho RF, Palmer KJ, Rocco B, Moniz RR, Chauhan S, Orvieto MA et al (2010) Early complication rates in a single-surgeon series of 2500 robotic-assisted radical prostatectomies: report applying a standardized grading system. Eur Urol 57:945–952PubMedCrossRefGoogle Scholar
  9. 9.
    Menon M, Shrivastava A, Tewari A, Sarle R, Hemal A, Peabody JO et al (2002) Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168(3):945–949PubMedCrossRefGoogle Scholar
  10. 10.
    Gupta NP, Nayyar R, Hemal AK, Mukherjee S, Kumar R, Dogra PN (2010) Outcome analysis of robotic pyeloplasty: a large single-centre experience. BJU Int 105:980–983PubMedCrossRefGoogle Scholar
  11. 11.
    Gettman MT, Peschel R, Neururer R, Bartsch G (2002) A comparison of laparoscopic pyeloplasty performed with the daVinci robotic system versus standard laparoscopic techniques: initial clinical results. Eur Urol 42:453–457PubMedCrossRefGoogle Scholar
  12. 12.
    Hemal AK, Mukherjee S, Singh K (2010) Laparoscopic pyeloplasty versus robotic pyeloplasty for ureteropelvic junction obstruction: a series of 60 cases performed by a single surgeon. Can J Urol 17:5012–5016PubMedGoogle Scholar
  13. 13.
    Nayyar R, Gupta NP, Hemal AK (2010) Robotic management of complicated ureteropelvic junction obstruction. World J Urol 28:599–602PubMedCrossRefGoogle Scholar
  14. 14.
    Gupta NP, Mukherjee S, Nayyar R, Hemal AK, Kumar R (2009) Transmesocolic robot-assisted pyeloplasty: single center experience. J Endourol 23:945–948PubMedCrossRefGoogle Scholar
  15. 15.
    Richards KA, Hemal AK, Kader AK, Pettus JA (2010) Robot assisted laparoscopic pelvic lymphadenectomy at the time of radical cystectomy rivals that of open surgery: single institution report. Urology 76:1400–1404PubMedCrossRefGoogle Scholar
  16. 16.
    Hemal AK, Abol-Enein H, Tewari A, Shrivastava A, Shoma AM, Ghoneim MA et al (2004) Robotic radical cystectomy and urinary diversion in the management of bladder cancer. Urol Clin North Am 31:719–729PubMedCrossRefGoogle Scholar
  17. 17.
    Menon M, Hemal AK, Tewari A, Shrivastava A, Shoma AM, Abol-Ein H et al (2004) Robot-assisted radical cystectomy and urinary diversion in female patients: technique with preservation of the uterus and vagina. J Am Coll Surg 198:386–393PubMedCrossRefGoogle Scholar
  18. 18.
    Menon M, Hemal AK, Tewari A, Shrivastava A, Shoma AM, El-Tabey NA et al (2003) Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int 92:232–236PubMedCrossRefGoogle Scholar
  19. 19.
    Pruthi RS, Nielsen ME, Nix J, Smith A, Schultz H, Wallen EM (2010) Robotic radical cystectomy for bladder cancer: surgical and pathological outcomes in 100 consecutive cases. J Urol 183:510–514PubMedCrossRefGoogle Scholar
  20. 20.
    Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS (2010) Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol 57:196–201PubMedCrossRefGoogle Scholar
  21. 21.
    Gettman MT, Blute ML, Chow GK, Neururer R, Bartsch G, Peschel R (2004) Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with daVinci robotic system. Urology 64:914–918PubMedCrossRefGoogle Scholar
  22. 22.
    Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M et al (2009) Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes. J Urol 182:866–872PubMedCrossRefGoogle Scholar
  23. 23.
    Wang AJ, Bhayani SB (2009) Robotic partial nephrectomy versus laparoscopic partial nephrectomy for renal cell carcinoma: single-surgeon analysis of >100 consecutive procedures. Urology 73:306–310PubMedCrossRefGoogle Scholar
  24. 24.
    Scoll BJ, Uzzo RG, Chen DY, Boorjian SA, Kutikov A, Manley BJ et al (2010) Robot-assisted partial nephrectomy: a large single-institutional experience. Urology 75:1328–1334PubMedCentralPubMedCrossRefGoogle Scholar
  25. 25.
    Hammad FT (2008) Radical prostatectomy. Ann N Y Acad Sci 1138:267–277PubMedCrossRefGoogle Scholar
  26. 26.
    Guillonneau B, Vallancien G (1999) Laparoscopic radical prostatectomy: initial experience and preliminary assessment after 65 operations. Prostate 39(1):71–75PubMedCrossRefGoogle Scholar
  27. 27.
    Binder J, Kramer W (2001) Robotically-assisted laparoscopic radical prostatectomy. BJU Int 87(4):408–410PubMedCrossRefGoogle Scholar
  28. 28.
    Patel VR, Tully AS, Holmes R et al (2005) Robotic radical prostatectomy in the community setting. The learning curve and beyond: initial 200 cases. J Urol 174:269–272PubMedCrossRefGoogle Scholar
  29. 29.
    Ficarra E, Cavalleri S, Novara G et al (2007) Evidence from robot-assisted laparoscopic radical prostatectomy: a systematic review. Eur Urol 51:45–56PubMedCrossRefGoogle Scholar
  30. 30.
    Hu JC, Wang Q, Pashos CL, Lipsitz SR, Keating NL (2008) Utilization and outcomes of minimally invasive radical prostatectomy. J Clin Oncol 26(14):2278–2284PubMedCrossRefGoogle Scholar
  31. 31.
    Badani KK, Kaul S, Menon M (2007) Evolution of robotic radical prostatectomy: assessment after 2766 procedures. Cancer 110(9):1951–1958PubMedCrossRefGoogle Scholar
  32. 32.
    John H (2008) Robotic laparoscopic radical prostatectomy: update 2008. Urologe A 47(3):291–298PubMedCrossRefGoogle Scholar
  33. 33.
    Orvieto MA, Patel VR (2009) Evolution of robot-assisted radical prostatectomy. Scand J Surg 98(2):76–88PubMedGoogle Scholar
  34. 34.
    Hu JC, Hevelone ND, Ferreira MD et al (2008) Patterns of care for radical prostatectomy in the United States from 2003 to 2005. J Urol 180(5):1969–1974PubMedCrossRefGoogle Scholar
  35. 35.
    Wagner A, Wei T, Dunn R et al (2007) Patient-reported outcomes after retropubic, laparoscopic, or robotic-assisted prostatectomy: results from a prospective, multi-center study. J Urol 177(Suppl 1):184Google Scholar
  36. 36.
    Krambeck AE, DiMarco DS, Rangel LJ et al (2009) Radical prostatectomy for prostatic adenocarcinoma: a matched comparison of open retropubic and robot-assisted techniques. BJU Int 103(4):448–453PubMedCrossRefGoogle Scholar
  37. 37.
    Hakimi AA, Feder M, Ghavamian R (2007) Minimally invasive approaches to prostate cancer: a review of the current literature. Urol J 4(3):130–137PubMedGoogle Scholar
  38. 38.
    Hegarty NJ, Kaouk JH (2006) Radical prostatectomy: a comparison of open, laparoscopic and robot-assisted laparoscopic techniques. Can J Urol 13:56–61PubMedGoogle Scholar
  39. 39.
    Menon M (2011) Robot-assisted radical prostatectomy: is the dust settling? Eur Urol 59:7–9PubMedCrossRefGoogle Scholar
  40. 40.
    Yoshioka K et al (2008) Robotic-assisted laparoscopic radical prostatectomy: initial 15 cases in Japan. J Robotic Surg 2:85–88CrossRefGoogle Scholar
  41. 41.
    Hashimoto T et al (2013) Predictors for positive surgical margins after robot-assisted radical prostatectomy: a single surgeon’s series in Japan. Int J Urol 20:873–878PubMedCrossRefGoogle Scholar
  42. 42.
    Gondo T et al (2012) The powerful impact of double-layered posterior rhabdosphincter reconstruction on early recovery of urinary continence after robot-assisted radical prostatectomy. J Endourol 26:1159–1164PubMedCrossRefGoogle Scholar
  43. 43.
    Jemal A, Siegel R, Ward E (2010) Cancer statistics, 2010. CA Cancer J Clin 60:277–300PubMedCrossRefGoogle Scholar
  44. 44.
    Smith AB et al (2010) Current status of robot-assisted radical cystectomy. Curr Opin Urol 20:60–64PubMedCrossRefGoogle Scholar
  45. 45.
    Parekh DJ et al (2013) Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol 189(2):474–479PubMedCrossRefGoogle Scholar
  46. 46.
    Hellenthal NJ et al (2010) Surgical margin status after robot assisted radical cystectomy: results from the international robotic cystectomy consortium. J Urol 184:87–91PubMedCrossRefGoogle Scholar
  47. 47.
    Jonsson MN et al (2011) Robot-assisted radical cystectomy with intracorporeal urinary diversion in patients with transitional cell carcinoma of the bladder. Eur Urol 60:1066–1073PubMedCrossRefGoogle Scholar
  48. 48.
    Gondo T et al (2012) Robotic versus open radical cystectomy: prospective comparison of perioperative and pathologic outcomes in Japan. Jpn J Clin Oncol 42:625–631PubMedCrossRefGoogle Scholar
  49. 49.
    Yin M, Yang XQ, Li RB, Yang YQ, Yang M (2009) Retroperitoneal laparoscopic nephron-sparing surgery for renal tumors. Zhonghua Yi Xue Za Zhi 89:1983–1985PubMedGoogle Scholar
  50. 50.
    Lane BR, Gill IS (2007) 5-year outcomes of laparoscopic partial nephrectomy. J Urol 177:70–74PubMedCrossRefGoogle Scholar
  51. 51.
    Gill IS, Lane BR, Blute ML, Babineau D, Colombo JR Jr, Frank I et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46PubMedCrossRefGoogle Scholar
  52. 52.
    Lane BR, Babineau D, Fergany AF, Kaouk JH, Gill IS (2008) Comparison of laparoscopic and open partial nephrectomy for tumor in a solitary kidney. J Urol 179:847–851PubMedCrossRefGoogle Scholar
  53. 53.
    Brandina R, Aron M (2010) Laparoscopic partial nephrectomy: advances since 2005. Curr Opin Urol 20:111–118PubMedCrossRefGoogle Scholar
  54. 54.
    Colli J, Martin B, Purcell M, Kim YI, Busby EJ (2011) Surgical factors affecting return of renal function after partial nephrectomy. Int Urol Nephrol 43(1):131–137PubMedCrossRefGoogle Scholar
  55. 55.
    Huang WC, Levey AS, Serio AM, Snyder M, Vickers AJ, Raj GV et al (2006) Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol 7:735–740PubMedCentralPubMedCrossRefGoogle Scholar
  56. 56.
    Viprakasit DP, Altamar HO, Miller NL, Herrell SD (2010) Selective renal parenchymal clamping in robotic partial nephrectomy: initial experience. Urology 76:750–753PubMedCrossRefGoogle Scholar
  57. 57.
    Haseebuddin M, Benway BM, Cabello JM, Bhayani SB (2010) Robot-assisted partial nephrectomy: evaluation of learning curve for an experienced renal surgeon. J Endourol 24:57–61PubMedCrossRefGoogle Scholar
  58. 58.
    Haber GP, Crouzet S, Kamoi K, Berger A, Aron M, Goel R et al (2008) Robotic NOTES (natural orifice translumenal endoscopic surgery) in reconstructive urology: initial laboratory experience. Urology 71:996–1000PubMedCrossRefGoogle Scholar
  59. 59.
    Dominguez-Escrig JL, Vasdev N, O’Riordon A, Soomro N (2011) Laparoscopic partial nephrectomy: technical considerations and an update. J Minim Access Surg 7(4):205–221PubMedCentralPubMedCrossRefGoogle Scholar

Copyright information

© Springer Japan 2014

Authors and Affiliations

  1. 1.Department of UrologyTokyo Medical UniversityTokyoJapan

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