Robotic-assisted surgery and treatment of urolithiasis: Beyond the Abstract

Urology, among the surgical specialties has been at the forefront of embracing new technology. This has not only helped in improving the surgical outcomes but has also provided our patients with more options of treatment to suit their peculiar needs. Treatment of urolithiasis is probably the best example where many efficient treatment options are available ranging from medical treatment, to extracorporeal shock wave treatment and a variety of minimally invasive alternatives including robot assisted surgery.

Size, site and composition of stone are usually the key factors considered by the urologists during decision making but when there is an associated anatomical abnormality, the choices of treatment are limited. Robot assisted surgical system has contributed significantly in improving the outcomes in such situations where complex reconstruction is required. In the article published in International Journal of Surgery, we reviewed the status of robot assisted surgery for treatment of urolithiasis. 

The modern surgical robot used in clinical practice today was introduced by Intuitive Surgical Inc. (Sunnyvale, CA) as the daVinci® Surgical System in 2000. Since then, this system has undergone several software and design upgrades but still it is a relatively newer system and only a hand full of studies are available which have reported on long term outcomes of its utility in the management of urolithiasis. Compared to pure laparoscopy, the added advantages of high definition screen with 3-dimensional visualization, zooming capabilities, better spatial and visual alignment and motion scaling technology with tremor filtration are undeniable benefits which make robot assistance an ideal system for treatment of conditions like simultaneous pyeloplasty -pyelolithotomy. A current review of the literature confirms this notion as studies reporting on operative data as well as long term results of simultaneous pyelolithotomy – pyeloplasty have shown effective and durable drainage of the reconstructed pelviureteric system. Concomitant renal stone with ureteropelvic junction obstruction may be present in up to 30% of patients and thus, many patients may potentially benefit from this approach. Other indications like complex pyelolithotomy and stone extraction with simultaneous partial nephrectomy are being continuously documented. In our opinion, the field of urology would greatly benefit from large, multi-institutional studies that evaluate the effective advantages of the robotic approach against well-established methodologies in the treatment of stone disease. 

Today, the main biggest challenge for wider use of robotic assist systems in the treatment of urolithiasis remains the lack of robotic system in areas where stone disease is endemic. It is anticipated that with an increasing number of users, this technology may become more affordable and percolate into these needed areas around the world. Until then, the indications for robotic assisted procedure in treatment of urolithiasis are expected to remain limited.

Written by: Khurram Siddiqui and David M Albala

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