What is Minimally Invasive Surgery (MIS)?
MIS is a less invasive approach compared to open surgery. This procedure is performed by advancing surgical instruments and telescopes through small incisions to the area to be operated and using these instruments. The advantages of this method are less surgical pain, less surgical scars, less hospitalization, and faster return to daily activities. The surgeon performing these operations should have very good experience both in these robotic operations and in classical open operations. MIS is not suitable for every patient. Your surgeon will advise you in which cases this method may be the best option.
What are the MIS types?
MIC types can be roughly divided into three.
- Laparoscopic surgery: It is the most common form of MIC. In laparoscopy, the surgeon initially makes small incisions in the patient's skin. Working channels called trocars are placed through these incisions. Then, the laparoscopic instruments and the lighted telescope, which allows to see the inside of the body, are advanced through these channels and the area to be operated is reached. Depending on the type of operation to be performed and the surgeon's preference, the operation can be performed from the front, back or side of the patient. This method is successfully applied in the surgery of organs such as kidney, ureter, bladder, and prostate in urology. However, it has disadvantages such as problems with tools, lack of skill and lack of depth perception.
- Endoscopic procedures (endourology): In this type of surgery, the body's natural openings are used. Such procedures in urology are cystoscopy (looking inside the bladder), ureterorenoscopy (looking inside the ureter and kidneys), and percutaneous nephroscopy (reaching the kidney through the incisions made on the back skin and looking inside the kidney). Such endoscopic procedures are widely used in the diagnosis and treatment of stones in the bladder, ureters, and kidneys, vesicoureteral reflux, which is the backflow of urine from the bladder to the kidneys, and conditions obstructing the urinary system (ureteropelvic junction stenosis, ureterovesical junction stricture, ureter, and urethral strictures).
- Robotic surgery: It is one of the most exciting procedures in the minimally invasive surgery field. This method provides the surgeon with better control and vision of the operation area, which is not available in conventional laparoscopy. All kinds of thin wrist, hand and finger movements of the surgeon are reflected on the robotic instruments on the patient's body. This reflection provides great convenience to the surgeon in performing complex urology surgeries.
How is robotic surgery performed?
This surgical method is performed by an experienced surgeon using robotic technology. Like laparoscopy, robotic surgery is performed by making small incisions in the skin and inserting robotic instruments and a light telescope into them. The surgeon who performs the operation does not stand by the patient as in classical surgery. Instead, it performs the operation by sitting on the console of the robot. An assistant surgeon is at the patient's bedside and assists the console surgeon.
What are the advantages of robotic surgery compared to laparoscopicsurgery?
Robotic operations take less time than laparoscopic operations. There is a direct relationship between the time spent under anesthesia and post-surgical complications. Fast surgery = less anesthesia and less complications. The surgeon can see the operation area in three dimensions, which is not possible in classical laparoscopy. In addition, depth perception cannot be found in classical laparoscopy due to the two-dimensional image.
Why should robotic surgery be preferred to open surgery?
An experienced surgeon who has received robotic surgery training can perform complex operations from small incisions. This reduces post-operative pain, shortens the time to stand up and stay in hospital, and reduces scar formation. In addition, since the surgeon sees the operating field better thanks to the high-tech robot, he feels better, and this reduces postoperative complications.
Are there difficulties in robotic surgery?
Disadvantages of robotic surgery; the lack of sense of touch, the longtime taken for the installation and removal of the robotic system, the risk of mechanical failure of the device and the high cost of the system. The sense of touch cannot be used during cutting and separating the tissues, and these processes are carried out entirely with visual stimuli. Although the stage of setting up the robot for surgery seems to be a disadvantage that prolongs the time, new robot models released to the market have begun to shorten and facilitate this stage. Another problem that arises in complex technologies such as robotic surgery is the occurrence of mechanical failure during the case. If the failure cannot be corrected, it may be necessary to switch to an open or laparoscopic surgical procedure for the continuation of the case. The rate of mechanical failure or functional failure was given as 2.4% and the rate of conversion to an open or laparoscopic procedure was 0.17%. Considering the mechanical problems, the robotic systems on the market today are quite reliable. The most important factor limiting the widespread use of robotic technologies is the financial problem. The cost required for the centers dealing with minimal interventional surgery to purchase the robot and to have it maintained after receiving it is quite high. In addition, a problem encountered in children is the lack of instruments in pediatric sizes and the working area can be small and insufficient in pediatric cases. 6 cm instrument spacing is ideal when placing robotic trocars; however, the small abdomen in pediatric cases limits this situation. The problem of the small working area encountered in children is solved by using the transperitoneal route where possible.
Does the robot perform the surgery itself?
The robot cannot make decisions and operate on its own. The robot is a surgical system and requires an experienced surgeon to operate it. Robotic technology is constantly controlled by the surgeon during the operation. You can think of the robot as an extension of the surgeon's hands.
How safe is robotic surgery?
I have successfully performed all robotic surgery procedures that have proven superiority and benefit over classical open surgery in the institutions I work for. The operation area of the organs located in the human body is better seen in robotic surgery. In addition, fewer stitches are required in robotic surgery, which contributes to the above-mentioned advantages.
How do you know if you are suitable for robotic surgery?
Many factors such as physical examination, medical and surgical history, and diagnosis of the disease are effective in making this decision. Each patient who will undergo robotic surgery is examined and evaluated in detail by me before the operation.
In which diseases are robotic systems applied in the field of urology?
In adults, all kinds of reshaping (reconstruction) operations applied in cases of kidney, adrenal gland, ureter, bladder and especially prostate cancer surgeries and obstruction causing dysfunction of these organs are successfully performed with a robotic system.
The second group of patients is children. Many surgeries have been described in children, whose feasibility and safety have also been demonstrated. The most common robotic operation in children is pyeloplasty for ureteropelvic junction obstruction. Other procedures are nephrectomy, heminephroureterectomy (removal of the ureter and the non-functioning half of the kidney), correction of vesicoureteral reflux, which is the leakage of urine from the bladder to the ureters (ureteral reimplantation), correction of ureterovesical junction stenosis, which is the stenosis at the entrance of the ureter to the urinary bladder (ureteral reimplantation), removal of the bladder diverticulum(excision), bladder augmentationand appendicovesicostomy.
In which centers are robotic urological surgeries performed in our country?
A wide variety of robot surgeries are performed in approximately 36 centers in our country. Almost all these operations are performed on adults. Robotic urological surgeries performed in children are not very common surgeries in Turkey yet and are performed only in a few centers in our country.