Complete robot-assisted laparoscopic urologic surgery: a preliminary report

Abstract

Background: The feasibility and applicability of using surgeon-controlled robotic arms as a substitute for surgical assistants during urologic laparoscopic surgery was assessed.

Study design: Seventeen laparoscopic procedures (nephrectomy, n = 4; retroperitoneal lymph node sampling, n = 2; varix ligation, n = 2; pyeloplasty, n = 3; Burch bladder suspension, n = 2; pelvic lymph node dissection, n = 1; orchiopexy, n = 1; ureterolysis, n = 1; and nephropexy, n = 1) were performed by a single laparoscopic surgeon assisted by one or two robotic arms directly controlled by the operating surgeon. One robotic arm controlled the laparoscope and was maneuvered by a foot pedal. The second robotic arm served as a retractor and was manipulated by a hand control. Assessment of robotic positioning, laparoscopic instrument port placement, time for setup and breakdown of the operative field, operative time, outcome, and operative complications were made for each procedure and compared with historical human-assisted laparoscopic procedures.

Results: Standard laparoscopic port placement was adequate for use of the robotic arms. All procedures were successfully completed with three minor surgical complications not related to the use of the robotic arm. Robotic arm positioning on the operating room table differed for each type of procedure, yet placement of the robotic arm controlling the laparoscope on the surgeon's side provided optimal surgical views. In three cases, intraoperative bleeding required human assistance for camera control. There was no increase in operating time when the robotic arms were used. There was no difference between the setup and breakdown time for this series of complete robot-assisted procedures when compared with either a nonrobot-assisted series (p > 0.05) or another robotic series completed prior to initiation of this study when no focus was made on setup and breakdown times and in which the robotic arm and human surgical assistant were compared (p < 0.05).

Conclusions: We found that simultaneous use of remote controlled robotic arms as surgical assistants is feasible in genitourinary laparoscopic surgery. The potential long-term cost effectiveness of using robotic surgical assistants in laparoscopic surgery highlights the economic impact of this research and warrants further investigation.