THE EFFECTIVENESS OF MININVASIVE ROBOTIC SURGERY IN UROLOGICAL FIELD

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We talk about it with Daniele Minardi Consultant Urologist in Dubai

Man-controlled but with superior precision. We are talking about the Da Vinci Robot - conceived by the Intuitive Surgical in 1999 as a tribute to the great Leonardo - a cutting-edge and high precision instrument that helps the surgeon in the operating room. The device, which does not act autonomously but is always guided by the specialist, is becoming increasingly popular all over the world, so that in a decade it has been used for surgical procedures on over 2 million patients. Also in Italy the robot is widely used in the field of general surgery, vascular, cardiac surgery and thoracic, gynecological, but above all urological (more than 67% of operations).

What are the advantages of using minimally invasive robotic surgery in Urology? For the Journal of Italian Healthcare World, Prof. Daniele Minardi Consultant Urologist for some years in Dubai (UAE).

Prof. Daniele Minardi

Prof. Minardi, what is Urology and what are the fields of competence?

Urology has developed enormously in recent decades and there are numerous fields of expertise: it treats diseases of the urinary and male genital tract in several aspects; he is interested in Oncology, Voiting Dysfunction and Neurourology, Calcolosis, Andrology, and also in the field of Female Urology. There are numerous therapeutic procedures of relevance: open surgery, laparoscopy, endourology and ESWL, kidney transplants, minimally invasive surgery and robotics.

What did the arrival of technology in urological surgery entail?

"It has brought about profound changes in the ability to diagnose and treat most diseases. By definition, surgery is invasive and may be associated with peri / post-operative and long-term complications. The introduction of endoscopic, laparoscopic and robotic urological surgery has revolutionized the management of urological diseases compared to previous years. These techniques are generally associated with a minor trauma to the patient compared to the traditional approaches. The surgeon has a better vision of the surgical field thanks to the optical enlargement thus allowing more accurate and precise movements ".

What are the main purposes?

For the surgeon a greater ability to treat increasingly complex cases while for the patient a more rapid recovery of the functional aspects and a better quality of post-operative life.

When to undergo surgery with the robotic technology?

The robotic technique of radical prostatectomy accounts for more than 70% of the operations performed for prostate cancer. Numerous studies have also supported the safety and feasibility of robot-assisted partial nephrectomy in case of organ-confined kidney cancer. Furthermore, other urological procedures, such as cystectomy or the correction of a pyelo-ureteral junction obstruction in patients presenting this malformation and other surgical procedures are also done by the robotic technique.

The da Vinci Robot. What are the main features of this innovative tool and the differences with traditional methods?

Robotic technology has been adopted rapidly over the past few years and is currently used routinely in surgery. The technological refinement developed by the manufacturer (Intuitive Surgical) has contributed to the constant diffusion of the system. The Da Vinci Robot has some technical advantages over traditional laparoscopy: in particular, the three-dimensional vision, the high degree of freedom of surgical instruments and the intuitive movements made possible by the endowritst instrumentation, allow a better vision of the anatomical structures and a more precise dissection . The da Vinci Robot allows the surgeon who is at the console to remotely control and maneuver the robotic arms, thus having the possibility of performing laparoscopic procedures in an easier way.

What are the advantages for the patient?

Compared to traditional open surgery, a lower hospital stay, less post-operative pain, reduced surgical scar extension with lower risk of surgical wound infection. Furthermore, it has been observed that robotic radical prostatectomy has a lower risk of intraoperative complications compared to laparoscopy, and a lower rate of positive surgical margins; these data are very important, as they are linked to a lower risk of recurrence of the disease with the consequence of reduction of further treatments. These data must be taken into account in health economics. With robotic surgery compared to open and laparoscopic surgery there is a lower incidence of blood transfusions.

Conversely, are there any disadvantages? If yes, which ones?

The robot cannot be handled by the surgeon without a preparation that takes place through specific training. Furthermore, the Da Vinci robotic system has high fixed costs, roughly 2.5 million euros for each piece of equipment, and maintenance. The use of the robotic system can also require longer surgical times, at least initially; this is due to the robot preparation and docking procedures. However, compared to open surgery the added costs will be balanced by a reduction in the number of days of admission and by a gain in patient productivity, which can return earlier to work.  

When did you approach robotic surgery?

My experience in robotic surgery began in 2012 at Guy's Hospital, King's College, London, one of the largest university centers for robotic surgery. Then I continued to Italy.

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