The age of robotic surgery - Is laparoscopy dead?

Abstract

Introduction: Robot-assisted laparoscopic surgery (RALS) has become a widely used technology in urology. Urological procedures that are now being routinely performed robotically are: radical prostatectomy (RP), radical cystectomy (RC), renal procedures - mainly partial nephrectomy (PN), and pyeloplasty, as well as ureteric re-implantation and adrenalectomy.

Methods: This non-systematic review of the literature examines the effectiveness of RALS compared with conventional laparoscopic surgery for the most relevant urological procedures.

Results: For robot-assisted RP there seems to be an advantage in terms of continence and potency over laparoscopy. Robot-assisted RC seems equal in terms of oncological outcome but with lower complication rates; however, the effect of intracorporeal urinary diversion has hardly been examined. Robotic PN has proven safe and is most likely superior to conventional laparoscopy, whereas there does not seem to be a real advantage for the robot in radical nephrectomy. For reconstructive procedures, e.g. pyeloplasty and ureteric re-implantation, there seems to be advantages in terms of operating time.

Conclusions: We found substantial, albeit mostly low-quality evidence, that robotic operations can have better outcomes than procedures performed laparoscopically. However, in light of the significant costs and because high-quality data from prospective randomised trials are still missing, conventional urological laparoscopy is certainly not 'dead' yet.

Keywords: (RA)PN, (robot-assisted) partial nephrectomy; (RA)RN, (robot-assisted) radical nephrectomy; (RA)RP, (robot-assisted) radical prostatectomy; (RA-)RPLND, (robot-assisted) retroperitoneal lymphadenectomy (RA)RC, (robot-assisted) radical cystectomy; 3D, three-dimensional; EAU, European Association of Urology; ICG, indocyanine green; IVC, inferior vena cava; Laparoscopic; NSGCT, non-seminomatous germ cell tumour; PSM, positive surgical margin; RAIL, robot-assisted inguinal lymphadenectomy; RALS, robot-assisted laparoscopic surgery; RALUR, robot-assisted laparoscopic ureteric re-implantation; Robotic; Robotic urological surgery; Robotic-assisted radical prostatectomy; WIT, warm ischaemia time; dVSS, da Vinci Surgical System.