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Urologic

CHI Memorial Computer and Robotics Enhanced Surgery Center offers robotic-assisted prostatectomy, cystectomy and nephrectomy using the da Vinci ® Surgical System.


Prostatectomy for Prostate Cancer

Prostate cancer is the most common cancer in men, and when complete removal of the prostate is indicated robotic-assisted prostatectomy (prostate removal) is a less invasive option. Using the da Vinci® Surgical System, the surgeon makes five to six keyhole incisions, measuring less than half an inch, around the lower abdomen.

The robotic arms of the da Vinci® system operate within these ports, with the surgeon in full control of their actions throughout the procedure - the system cannot be programmed nor can it make decisions on its own. Additionally, there are sensors on the machine that ensure the robotic arms move only when the surgeon's eyes are viewing the console display.

In addition to eliminating the need for long incisions, the da Vinci® system also mimics the movement of the surgeon's wrist within the patient's body. The computer automatically removes the natural tremor of the surgeon and also improves the fine control of the manipulations. Larger movements on the console arms manipulated by the surgeon are reduced or scaled down to smaller movements by the robotic arms in the patient. This allows delicate dissection and suturing not possible with regular laparoscopic instruments and with better vision than through a regular large incision. One incision, for example, specifically is reserved for a robotic arm outfitted with a camera. Images from the camera are transmitted to a high-definition monitor at the surgeon console.

The less invasive aspect of the robotic-assisted prostatectomy does not compromise the surgeon's ability to remove the prostate gland completely. Rather, cancer can be controlled just as - if not more - effectively with robotic techniques as they are with open surgery. In turn, it helps preserve erectile function, continence and quality of life.

Benefits of robotic-assisted prostatectomy:

  • improved cancer control
  • lower incidences of incontinence and erectile dysfunction
  • less pain
  • less risk of wound infection
  • less blood loss
  • less scarring
  • faster recovery
  • quicker return to normal activities

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. Always ask your doctor about all treatment options, as well as their risks and benefits.

The following table provides an overview of the differences in benefits for patients and surgeons between the robotic-assisted radical prostatectomy and more traditional approaches:

Procedure Operating Time Average Length of Hospital Stay Total Incision Length Estimated Blood Loss Return to Continence Visualization Magnification of Visualization
Open Radical Prostatectomy 2.5 to 3.5 hours 2 to 4 days 8 to 10 inches 375 cc 90% 3-D Up to three times
Laparoscopic Radical Prostatectomy 3.5 to 6 hours 1.5 to 2.5 days 2 inches 400 cc 89% 2-D Up to six times
Robotic-Assisted Radical Prostatectomy


2 to 3 hours 1.5 to 2.5 days 2 inches less than 100 cc 94% 3-D 10 times

Watch a robotic-assisted prostatectomy, performed and narrated by C. Lee Jackson, M.D., urological oncologist.

Learn more about da Vinci® prostatectomy.


Robotic Simple Prostatectomy 

Frequent urination can reduce your quality of life, and problems with urination can lead to recurrent Infections of bladder stones – all symptoms of benign prostatic hyperplasia (BPH), or an enlarged prostate. The prostate surrounds the urethra, the tube that carries urine outside the body. When the prostate gland is enlarged, it can interfere with emptying your bladder. A simple prostatectomy with the da Vinci Surgical System is a minimally invasive procedure to remove the inner core of the prostate gland to remove the pressure on the urethra. 

Compared to open simple prostatectomy, robotic techniques allow more precise removal of the inner part of the prostate – all with smaller incisions, reduced blood loss, less need for blood transfusions, less pain, shorter hospital stay, and faster overall recovery. The exact incision locations are determined by the size of the prostate and the patient’s symptoms. In most procedures, the adenoma (the abnormally enlarged portion of the prostate) near the urethra is carefully removed, and the remaining parts of the gland are sewn back together to restore the normal prostate capsule. 

Recovery from robotic surgery is generally much easier than after open surgery. However, patients still usually need to use a catheter for several days before regaining control of urination (continence). Once it’s removed, it’s typical to see a significant improvement of urinary flow rates and bladder emptying. 

Learn more about da Vinci® prostatectomy.

Cystectomy

Bladder cancer accounts for about 5% of all new cancers in the US and is the fourth most common cancer in men.

Robotic-assisted partial cystectomy (bladder removal) is a less invasive option for tumor removal. Using the da Vinci® Surgical System, the surgeon can precisely visualize and remove the bladder tumor. In addition to eliminating the need for long incisions, the da Vinci® system also mimics the movement of the surgeon's wrist within the patient's body.

The computer automatically removes the natural tremor of the surgeon and also improves the fine control of the manipulations. Larger movements on the console arms manipulated by the surgeon are reduced or scaled down to smaller movements by the robotic arms in the patient. This allows delicate dissection and suturing not possible with regular laparoscopic instruments and with better vision than through a regular large incision.

One incision, for example, specifically is reserved for a robotic arm outfitted with a camera. Images from the camera are transmitted to a high-definition monitor at the surgeon console. With the use of the da Vinci® Surgical System, surgeons are able to perform a more precise operation compared to a traditional open cystectomy. Benefits to patients, compared to open surgery, include:

  • improved cancer control
  • smaller incisions
  • less hospitalization
  • Faster recovery

Learn more about da Vinci® cystectomy.


Robotic Ileal Conduit

In the treatment of bladder cancer, it’s often necessary to remove the bladder completely. Once the bladder is removed, urine is stored and passed out of the body in a new way. An ileal conduit is created to let the urine pass through a new opening in your lower abdomen (belly) called a urostomy.Using the da Vinci Surgical System, tiny instruments are inserted into small incisions in the abdomen. The surgeon controls these instruments through a computerized system and uses mini cameras on the instruments to send images to the video monitors. These larger-than-life images allow the surgeon to be very controlled and precise in their movements. A laparoscope (a long, thin, lighted telescope) is inserted through one of the incisions. The surgeon removes the bladder and other structures through the largest incision then creates a new storage area for urine, and connects a short piece of the small intestine (ileum) to to the ureters. One end of the conduit will be closed and the other end is pulled through the skin of the belly to create a new opening, commonly on the lower right side of the belly. 

It’s important to note that the robot is not performing the surgery. Your surgeon performs the surgery, but the da Vinci® Surgical System console allows for more controlled and precise movements.


Nephrectomy & Partial Nephrectomy 

Kidney cancer is among the 10 most common cancers in both men and women, and approximately 62,700 new cases of kidney cancer will occur this year, according to the American Cancer Society. Kidney tumors can be very aggressive. If caught early kidney cancer is treatable but once cancer has spread beyond the kidney it can be incurable. 

Robotic-assisted partial nephrectomy (kidney removal) is a less invasive option for tumor removal. Using the da Vinci Surgical System, the surgeon can precisely visualize and remove the tumor and cells surrounding the tumor to ensure cancer free margins. By leaving the majority healthy kidney cells, the patient will have maximum kidney function. 

In addition to eliminating the need for long incisions, the da Vinci system also mimics the movement of the surgeon's wrist within the patient's body. The computer automatically removes the natural tremor of the surgeon and also improves the fine control of the manipulations. Larger movements on the console arms manipulated by the surgeon are reduced or scaled down to smaller movements by the robotic arms in the patient. This allows delicate dissection and suturing not possible with regular laparoscopic instruments and with better vision than through a regular large incision. One incision, for example, specifically is reserved for a robotic arm outfitted with a camera. Images from the camera are transmitted to a high-definition monitor at the surgeon console.

With the use of the da Vinci Surgical System, surgeons are able to perform a more precise operation compared to a traditional open nephrectomy. Benefits to patients, compared to open surgery, include: 

  • equivalent cancer control 
  • smaller incisions 
  • less hospitalization 
  • faster recovery 

As with any surgery, these benefits cannot be guaranteed, as surgery is both patient- and procedure-specific. Always ask your doctor about all treatment options, as well as their risks and benefits. 


Robotic Pyeloplasty 

Robotic pyeloplasty is a minimally invasive surgery to remove blockages of the ureteropelvic junction (UPJ), the space where the kidney meets the ureter. In a healthy urinary tract, urine drains from the kidney into the ureter and then down to the bladder. When the UPJ narrows or becomes blocked, urine can back up in to the kidneys. Blockages can be present at birth or caused by kidney stones and scar tissue, which cause pain and blood in the urine. Over time it can lead to decreased kidney function or loss of a kidney. 

During robotic pyeloplasty, the surgeon places instruments inside the patient through several small incisions in the abdomen. These instruments are used to dissect the affected kidney and remove the blockage. The urinary tract is surgically reconstructed to repair any damage caused by fluid pressure buildup and prevent future blockages. A stent is placed temporarily to aid in healing and is removed after four weeks in the doctor’s office. 

Robotic pyeloplasty is less invasive than open surgery, and patients typically experience shorter hospital stays and can return to their daily activities quickly—often just 2 weeks after surgery, compared to 6 to 8 weeks for the open procedure. Other potential benefits include less post-operative pain and less risk of infection. 

Learn more about da Vinci® pyeloplasty.


Robotic Ureteral Re-Implantation 

When the kidneys make urine, it passes down a tube called the ureter to the bladder – where it’s stored and then eliminated. Where the ureter inserts into the bladder is called the ureterovesical junction. When this junction doesn’t perform properly or is damaged, it can be reattached to the bladder with ureteral re-implantation. 

CHI Memorial’s da Vinci robotic surgical system allows your doctor to perform a precise, minimally invasive procedure through a few tiny incisions with enhanced vision, dexterity and control. Benefits of robotic-assisted surgery over open surgery include significantly less pain, scaring and blood loss, lower risk of infection and need for blood transfusions, and shorter hospital stays and recovery time.