Robotic Surgery in Reconstructive Urology

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Presentation transcript:

Robotic Surgery in Reconstructive Urology Joseph Costa, DO Interim Chairman, Department of Urology Associate Professor of Surgery University of Florida College of Medicine-Jacksonville

Evolution of Surgical Technique Open surgical Laparoscopic Robotically assisted

www.emedicinehealth.com Amila Ratnayake 2013

J Urol. 1991 Aug;146(2):278-82.

Laparoscopic Approach Laparoscopic Approach http://www.devasyahospital.com/laparoscopic-nephrectomy/

2 year experience Laparoscopic nephrectomy, single institution experience N = 24 Greater mean operative time (6-7 hrs) Hospital stay 4 days Return to activity 3.4 weeks Return to work 6 weeks Br J Urol. 1994 Mar;73(3):231-6

Abbou, et al. 2001

Early Adoption Laparoscopic approach was superior for recovery, however, a tremendous learning curve existed for reconstructive techniques Purely laparoscopic surgery did not allow wristed joint articulation Purely laparoscopic surgery does not allow 3 dimensional visualization , depth perception is problematic Procedures intensive in suturing require wristed motion Try signing your name in cursive with a mouse adobe

November 2003 Volume 170 (5): 1738-41.

J Urol 174, 269-272, July 2005

Adoption of Robotic Prostatectomy

Evolution of reconstruction Oncology lead initial adoption Minimal reconstruction in oncologic procedures with exception of prostatectomy Nephrectomy, Colectomy, Hysterectomy, Cholecystectomy adopted early as ideal cases for laparoscopic approach Prostatectomy adopted more widely only after adaptation to Robotic assisted approach

Urology. 2016 Aug;94:123-8.

Richstone L, Scherr D. http://abdominalkey

Urology. 2016 Aug;94:123-8.

Open vs. MIS approach: Adult Ureteral Reimplantation Laparoscopic (n=300) Length of stay (Days) 4 1 Transfusion 24 Wound Complications 19 2 Re-Operation 8 26 Re-Admission 22 14 Mortality Urology. 2016 Aug;94:123-8.

Vaginal Prolapse Repair Multi-Center study , N = 78 (38 Lap, 40 Robot) 97-100% subjective improvement Significant improvement in validated questionnaires 3 Reoperative cases for bowel complications Female Pelvic Med Reconstr Surg. 2016 ; 22(5): 382–384.

Obstet Gynecol Sci. 2016 Jul;59(4):253-260.

579 × 306 - urobriz.com.au http://urology.jhu.edu/MIS/lap_pyeloplasty.php.

Ellsworth P, Kim E. eMedicine 2016

daVinci ©

daVinci ©

Cent European J Urol. 2016; 69: 217-220

Ileal Ureteral Interposition Chronic stent exchange Nephrectomy Intl J Braz Urol. Vol. 38 (6): 779-787, November - December, 2012 Korean J Urol. 2014 Nov;55(11):742-749.

Dielubanza et al. TAU, Vol 3, No.2 June 2014

Korean J Urol. 2015 Jul;56(7):478-486

Cent European J Urol. 2016; 69: 217-220

Evolution of reconstruction First extirpation procedures lead the way Simple reconstruction (e.g. Prostatectomy) More complex reconstruction Abdominal Sacrocolpopexy Pyeloplasty Distal ureteral reimplantation Very complex reconstruction Long ureteral length reconstruction

Non-Prime Time, Future Practice Bowel reconstruction or urinary diversion Tissue transfer techniques

Thank You