Around 14 years ago the first prostate removal was performed using the Da Vinci surgical system. Thanks to its outstanding precision, today it is as well used on complex surgical procedures like kidney and bladder operations.
This da Vinci is not the famous artist and multi-talented genius Leonardo, but rather the fourth generation of the surgical robot that can be used to perform many complex operations. This technology builds on the advances made by keyhole surgery and is primarily used for urological operations such as the complete removal of the prostate, or kidney and bladder surgery. Other surgical disciplines are also discovering the advantages of this captivating machine, such as thoracic and abdominal surgery, heart surgery and gynaecology.
The old adage “great surgeons make great incisions” is now luckily a thing of the past. Today’s maxim is something more like “small but powerful”. The da Vinci surgical system is ideal if there is no need for open surgery. Its small incisions and extreme precision reduce the impact on important bodily structures, so many important physiological functions are retained and the patient enjoys greater quality of life. Patients also benefit from less pain, shorter hospital stays and the ability to resume their normal lives faster.
Prostatectomy: the most common operation
The most common procedure performed using the system is the complete removal of the prostate in cases of prostate cancer, the most common form of cancer among men over 50. The primary focus is on patient safety and the removal of the entire tumour, as well as the retention of important bodily functions. In particular, the aim is to avoid the onset of incontinence* and impotence*. The da Vinci surgical system enables surgeons to clearly identify nerves and muscles, making it easier to avoid any unintentional damage. During the procedure, a pathologist examines the tissue surrounding the removed prostate for signs of tumours. This helps the surgeon to decide whether to extend the operation and remove more tissue from the area. Thanks to the approach, the patient enjoys maximum safety and the best possible retention of their bodily functions.
Kidney preservation operations with good results
Since the system was launched around 14 years ago, its areas of application have continued to grow. Today pyeloplasty* and the removal of kidney tumours can be easily carried out laparoscopically* or with the assistance of robots. Open operations involving painful and restrictive large incisions in the groin area are now only necessary in a few exceptional cases, such as the removal of very large, infiltrating* tumours. International studies recommend preserving the kidneys if it is technically and anatomically possible, even in the case of larger tumours, as this enables the patient to live longer and enjoy better quality of life. The findings of many studies indicate that the loss of a kidney can later lead to renal failure* and a shorter life expectancy. Consequently, the retention of the kidneys and their associated functions is a top priority and is made possible through the use of minimally invasive, robot-assisted or laparoscopic techniques. Furthermore, these procedures involve less pain, shorter hospital stays and result in a more aesthetic outcome.
The limitations of the da Vinci surgical system
Within the field of urology, the da Vinci surgical system is not only used for prostate and kidney operations, but also bladder surgery. Although the system’s scope and capabilities are continually increasing, surgeons still need to individually appraise each case and identify when and where it would be inappropriate to use the technology. The surgeon’s technical ability and experience performing such procedures are crucial for making the most of this system, however, its potential is still limited by the type and location of the disease. The system is not suitable for treating very large, advanced tumours that have grown into the surrounding tissues. In such instances preference should be given to conventional open techniques, as the surgeon typically needs to rely on their sense of touch during the operation and this cannot be provided by a robot. No machine can replace a human when it comes to conducting sensitive conversations with the patient and taking each individual situation in consideration.
Glossary
Incontinence: Inability to hold in urine and faeces or to control urination/bowel movements
Impotence: Inability to gain or maintain an erection
Pyeloplasty: Removal of a constriction between the renal pelvis and the ureter, so that urine can easily flow out of the bladder
Laparoscopy: Minimally invasive surgical removal of tissue from the abdomen with the aid of an optical instrument
Infiltrating: Penetrating or growing into the surrounding tissue
Renal failure: Inability of the kidneys to sufficiently eliminate toxins from the body
Article from Prof.Dr. Martin Baumgartner, specialist in urology and Dr.med. Daniel Seiler, specialist in urology.