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

2. Evolution of Surgical Technique
Open surgical
Laparoscopic
Robotically assisted

3.                                       
Amila Ratnayake   2013

4. J Urol Aug;146(2):

5. Laparoscopic Approach
    
    
Laparoscopic Approach

6. 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 Mar;73(3):231-6

7. Abbou, et al. 2001

8. 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
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9. November 2003 Volume 170 (5):

10. J Urol 174, , July 2005

11. Adoption of Robotic Prostatectomy

12. 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

13. Urology Aug;94:123-8.

14. Richstone L, Scherr D. http://abdominalkey

15. Urology Aug;94:123-8.

16. 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 Aug;94:123-8.

17. 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 ; 22(5): 382–384.

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

21.                                               
579 × 306 - urobriz.com.au

22. Ellsworth P, Kim E. eMedicine 2016

23. daVinci ©

24. daVinci ©

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

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

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

30. Korean J Urol Jul;56(7):

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

32. 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

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

34. Thank You