Robotic surgery, also called robot-assisted surgery, is one of the biggest revolutions in medicine in recent decades. It allows surgeons, including the urologist, to perform many extremely complex surgeries with more precision, flexibility and control than is possible with conventional surgeries. Robotic surgery is included in the group of minimally invasive surgeries, surgeries performed through tiny incisions in the patient’s skin. Widely applied in the urological world, robotic surgery has been available to urologists in Brazil since 2008 and has been consolidating itself every day as superior when compared to conventional open surgery and traditional laparoscopic surgery.
The robotic system has devices called “surgical arms” that are remotely controlled by the urologist. These arms execute the commands given by the surgeon with maximum precision. Generally, one of the arms is used to insert the camera that will provide high resolution images of the surgical act and three arms with surgical instruments attached to them to perform the surgery.
The urologist controls the arms through a computerized console that is located next to the operating table. This console gives the urologist a three-dimensional, high-resolution, magnified view, allowing a much more accurate identification of the patient’s internal structures and making it possible to better preserve them, reducing complications. Surgical instruments have joints that allow movements in all directions with a tremor filter allowing greater delicacy and precision of movements; the robotic arms reproduce the movement performed by the urologist’s hand on the console.
The most important robotic surgery performed by the urologist is the surgery to remove the prostate, called robotic radical prostatectomy. It is the main treatment for prostate cancer. Due to the characteristics of robotic surgery of magnification and precision of movements, it is possible to better identify and preserve the structures called vascular-nervous bundles that are found in the vicinity of the prostate and that must be preserved to avoid serious complications of prostate surgery that are sexual impotence and urinary incontinence. The surgery is performed through tiny skin incisions of less than 1 centimeter each.
The duration of a robotic prostate surgery is around 2 to 4 hours, and it can be faster or longer depending on the complexity of the case.
With robotic prostate surgery, patients undergoing prostate removal surgery are generally discharged in less than 24 hours and have a faster recovery than patients operated on by traditional techniques.
Robotic radical prostatectomy is currently the most indicated surgical technique for the treatment of localized prostate cancer.
According to Federal Council of Medicine (CFM), robotic surgery has to be performed in a hospital that attends to high complexity and by at least two surgeons: one at the console and the other in the surgical field next to the patient, in addition to the rest of the team, anesthesiologists and nurses. The urologist must have specific training in robotic surgery to be able to perform the procedure. Autonomy to perform robotic surgery is allowed after proof of completion and approval in training with an instructor-surgeon, with the doctor having performed a minimum of 10 robotic surgeries.
The main advantages of robotic surgery are:
– smaller skin incisions;
– scars that are more discreet and aesthetically better;
– less pain;
– lower risk of bleeding;
– shorter hospital stay;
– lower rate of complications;
– lower rate of surgical wound infection;
– in the case of prostate cancer, less risk of sexual impotence and urinary incontinence;
– faster recovery and return to daily activities;
– Possibility of being carried out remotely in the future.
Regarding the disadvantages of the method, we can mention that it is still an expensive procedure and that it is not available in many cities and hospitals in Brazil, but that it is becoming more accessible every day. Robotic Surgery São Paulo is a reality in the main hospitals in the city.
For more details about robotic surgery, talk to your urologist about the risks and benefits of each type of procedure and how it compares to other surgical techniques.
Dr. Petronio Melo is certified in robotic surgery and is able to help you if you need to perform this type of surgical procedure.
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