Minimally invasive surgery in urology has come a long way since the initial report of laparoscopic nephrectomy in 1992. The days of scrutiny are long gone, and the robotic platform has further cemented minimally invasive surgery as the centerpiece of urologic oncologic surgery. Equivalence to open surgery has been demonstrated in every major urologic oncologic surgery.
Thanks to the technical benefits of the robotic system, utilization of minimally invasive techniques has increased over the last decade. The robotic approach has become the standard approach in performing radical prostatectomy and partial nephrectomy for small renal tumors in the United States. Even technically challenging procedures such as radical cystectomy and intracorporeal urinary diversion have been standardized in experienced centers.
This article examines current developments in robotic urologic surgery and future directions, including the introduction of alternative surgical robots.
Current state of robotic surgery
Currently Intuitive Surgical, Inc.’s da Vinci Surgical System is the only commercially available surgical system in the U.S. Now in its fourth generation, the current system provides finer surgical instruments and enables multi-quadrant surgery.
Even though the new model addressed some of these logistic and ergonomic issues, there remain purported limitations of the current platform. One such example is the lack of tactile feedback, which is a cornerstone for those trained in open and standard laparoscopy. Addition of this technology may facilitate a shorter learning curve and wider adoption among other specialties. The learning curve involved with mastering robotic surgery remains steep, requiring dedicated time and mentorship that take time away from a surgeon’s busy practice.