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Robotic Surgery: Urologic Procedures


Robotic Procedures

The Department of Urologic at Lenox Hill Hospital has performed hundreds of robotic procedures utilizing the da Vinci surgical system SI, the most sophisticated robotic technology available. Robotic surgery has proven benefits over traditional open surgery. These benefits include less postoperative pain, less measured blood loss, shorter hospitalizations, quicker recovery and resumption of normal activities sooner than patients undergoing traditional open surgery. Importantly, the oncologic (cancer control) and quality-of-life outcomes (erectile dysfunction and urinary continence) are similar to outcomes with traditional open surgery.

Robotic Assisted Urologic Procedures Performed:

  • Radical Prostatectomy
  • Pyeloplasty
  • Nephrectomy
  • Bladder Diverticulectomy
  • Ureteral Reimplantation

Our Surgeons

Lenox Hill Hospital's robotic urologic surgeons are extremely experienced in performing the above procedures. The department of Urology has put together an experienced team of nurses and doctors to provide outstanding surgical technique, compassionate care and superior outcomes.

Learn more about our surgeons by clicking on their names:

David Samadi, MD, Chairman, Department of Urology

Robotic Assisted Radical Prostatectomy

Benefits:

- Less tissue damage and scarring as a result of minimally invasive incisions.
- Less post-operative pain and discomfort.
- 3D visualization, offering surgeons a more accurate view of the operative field.
- Smaller incisions
- Less blood loss and minimal scarring.
- Shorter post operative recovery time with a more rapid return to normal activity.

Thanks to a breakthrough surgical technology, Lenox Hill Hospital's robotic urologic surgeons now offer a minimally invasive option for prostatectomy.

In prostate cancer treatment, millimeters matter. Nerve fibers and blood vessels are attached to the prostate gland. To spare these nerves, they must be delicately and precisely separated from the prostate before its removal. Surgeons use the precision, vision and control provided by da Vinci to assist them in removal of the cancerous prostate while preserving important nerves and blood vessels.

In terms of cancer control, in several large published studies da Vinci Prostatectomy has shown equal or lower rates of positive surgical margins (meaning margins with cancer cells left behind) than large studies of other forms of surgery.
The other great concerns for prostate cancer patients are: urinary continence and sexual function after treatment. Studies show patients who undergo a da Vinci Prostatectomy may experience a faster return of urinary continence following surgery and a lower rates of urinary pain than radiation (brachytherapy) patients. Several studies also show that patients who are potent prior to surgery have experienced a high level of recovery of sexual function (defined as an erection for intercourse) within 12 to 24 months following da Vinci Surgery.

It is important to know that da Vinci Surgery does not place a robot at the controls; Lenox Hill Hospital's robotic urologic surgeon is always in control of every aspect of the surgery with the assistance of the da Vinci robotic surgical system.

Prostectomy incision

Robotic Assisted Pyeloplasty

Kidney Disorders

The kidneys are two small fist-sized organs located behind the abdomen on each side of the spine. By producing urine, kidneys remove toxic by-products and excess fluids from the body to help maintain a critical balance of salt, potassium and acid.

Diseases of the kidney are found more often in racial and ethnic minority populations in the United States than in the Caucasian population. African Americans, Asian Americans, Hispanics/Latinos, and Pacific Islander Americans are three times more likely to suffer from kidney failure than Americans of European descent.

Urinary Obstruction

One of the most common conditions affecting the kidneys is urinary obstruction. Obstruction can occur anywhere in the urinary tract and when it occurs, medical attention is required. A urinary obstruction can create serious side effects like infections and kidney stones. If left untreated, blockages can cause chronic pain and may damage the kidney over time.

Blockage of the Ureter

The condition known as blockage of the ureter (tubes that transport urine from the kidneys to the bladder) is found in adults, but more commonly in children. Normally, a single ureter drains a single kidney but sometimes there may be two ureters draining one kidney. One ureter drains the upper part of the kidney and the second ureter drains the lower part. As long as they both enter the bladder normally, this "duplicated collecting system" is not a problem. In rare cases, a child may be born with an ectopic (abnormally positioned) ureter. This is a ureter that fails to connect properly to the bladder and instead drains somewhere outside the bladder. In girls, the ectopic ureter usually drains into the urethra or even the vagina. In boys, it usually drains into the urethra near the prostate or into the genital duct system. The urethra is a canal that carries the urine from the bladder and in males also serves as a passageway for semen.

UPJ Obstruction

The most common cause of obstruction in the urinary tract in children is a congenital obstruction. This occurs at the point where the ureter joins the renal pelvis (called the ureteropelvic junction or UPJ). This is the area at the center of the kidney where urine collects and is funneled into the ureter. This type of obstruction occurs in roughly one in 1,500 children. These obstructions develop prenatally as the kidney is forming. Today, most cases are diagnosed on prenatal ultrasound screening.

In UPJ obstruction, the kidney produces urine at a rate that exceeds the amount of urine able to drain out of the renal pelvis into the ureter. This causes an accumulation of urine in the kidney. The accumulation, also called hydronephrosis is visible on ultrasound and often allows the doctor to predict the presence of UPJ obstruction before the baby is born.
Although less common in adults, UPJ obstruction can occur as a result of kidney stones, previous surgery or disorders that cause inflammation of the upper urinary tract.

If your doctor recommends surgery to treat urinary obstruction, you may be a candidate for a new, minimally invasive approach. This surgery, known as pyeloplasty, removes the blockage in the urinary system. During surgery, your doctor will reattach the healthy part of the kidney to the healthy part of the ureter, the narrow tubes that carry urine from the kidneys to the bladder .

Robotic Assisted Radical/Partial Nephrectomy

Radical Nephrectomy versus Partial Nephrectomy (Kidney-sparing)

The removal of the entire kidney is called a radical nephrectomy. Depending on your disease state and tumor location, you may not have to lose your entire kidney to surgery. A surgical technique, called partial nephrectomy, aims to remove only the diseased part of your kidney and spare the healthy, functioning kidney tissue.

Sparing kidney tissue is important because studies show that patients who have their entire kidney removed are more likely to suffer from chronic kidney disease (CKD) after surgery compared to patients who receive a kidney sparing partial nephrectomy.

In fact, the American Urological Association states that partial nephrectomy is the gold standard treatment option for small to medium-sized kidney tumors or masses.

The da Vinci Surgical System uses state-of-the-art technology to help your doctor provide the gold standard treatment, where indicated, and also perform a more precise operation. da Vinci offers several potential benefits to patients facing kidney surgery, including:
-Excellent clinical outcomes and cancer control
-Short hospital stay
-Low blood loss
-Precise tumor removal and kidney reconstruction
-Excellent chance of preserving the kidney, in certain operations
-Low rate of operative complications

Kidney incision

Robotic Assisted Bladder Diverticulectomy

Robotic bladder diverticulectomy is performed to repair diverticula abnormal out- pouchings in the urinary bladder that form when the bladder lining protrudes through the bladder wall, creating a non contractile sac. These pouches may be caused by a congenital weakness in the bladder wall. However, the condition typically develops later in life due to blockage of the lower urinary tract that leads to increased pressure inside the bladder. This blockage is usually the result of benign prostate hypertrophy, or BPH (enlarged prostate) though it can also be caused by urethral strictures (narrowing of the urethra), or nerve damage that causes bladder dysfunction.

Bladder diverticula are associated with increased incidence of urinary tract infection and urinary tract stone development. Robotic bladder diverticulectomy is ideally suited to the repair of this condition. Not only does the minimally invasive approach lead to reduced post-operative discomfort and faster recovery time, but the excellent visualization provided by the da Vinci Si surgical system also facilitates the extensive urinary reconstruction required in the operation, resulting in minimal blood loss and often decreasing the operative time.

Advantages of Robotic Bladder Diverticulectomy

  • Less post-operative discomfort and scarring. Traditionally, a bladder diverticulectomy is performed using an open incision measuring 4 to 6 inches. Robotic surgery allows the same operation to be performed with several quarter-inch incisions, resulting in less pain and scarring.
  • Enhanced visualization and suturing ability. The robotic assisted technique provides 3-D visualization of the operating site and also allows significantly easier and more precise suturing.

Robotic Bladder Diverticulectomy at Lenox Hill Hospital

Lenox Hill Hospital robotic urologic surgeons have published on the technique for robotic bladder diverticulectomy. The initial results with this procedure have been excellent, and we continue to utilize this approach as our first line of treatment for patients requiring bladder diverticulectomy.