Departamento de Urologia CUF Tratamos Ensinamos Descobrimos Robotic

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Robotic surgery in urology European perspective Estevao Lima 2017

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos • HISTORY OF UROLOGIC ROBOTIC SURGERY • 1997 - The da Vinci Surgical System was released • 2000 - The da Vinci surgical system was approved by the FDA • Robotic surgeries are increasing in number and are becoming more popular

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos • Are robots more effective than laparoscopic surgery?

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos • Are robots more effective than laparoscopic surgery? • Robotic 3 D Vision is not an added advantage • Real Advantages of robots • Robotics makes surgeries extremely precise mainly the suture. • Robots reduce the learning curve for laparoscopic surgery • Robotic surgeries are ergonomically superior and cause less fatigue for surgeons

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Oncologic outcome of robot-assisted radical prostatectomy

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Conclusions and recommendations on incontinence outcomes of robotassisted radical prostatectomy The reason for these conclusions is the ease of suturing with the robot, mostly in surgeons with no experience in laparoscopy.

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Conclusions and recommendations on potency outcomes of robot-assisted radical prostatectomy

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos NEWER FRONTLINES IN RADICAL PROSTATECTOMY retzius-sparing prostatectomy - posterior approach

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos This surgical approach requires the use of robot.

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Robot-assisted radical nephrectomy Robotic in kidney surgery? § Described by the first time in 2000 § Limitations: ü Increased operative time - robot docking time ü higher cost per procedure ü No significant improvement in clinical outcomes

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos The outcomes of selected studies on robot-assisted partial nephrectomy compared with laparoscopic partial nephrectomy Robotic in partial nephrectomy?

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Conclusions and recommendations on robot-assisted radical nephrectomy and robot-assisted partial nephrectomy • Use laparoscopy for simple or radical nephrectomy. laparoscopic • Use robot-assisted or surgery for partial or reconstructive renal surgery if technically feasible. • Use of minimal invasive techniques should not compromise nephron-sparing surgery.

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Perioperative data, complications rates and oncologic outcomes of robot -assisted radical cystectomy Robotic approach can achieve a similar oncologic surgical quality to open approach and this depends more of the surgeon than the technology used.

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Robot-assisted radical cystectomy with urinary diversion performed intracorporeally it is only possible with the use of robot

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Robot-assisted kidney transplantation Promising technique that provides exceptional patients outcomes by reducing operative morbidity, immobilization and time to recovery.

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos • Take home message ØFor a majority of surgeries, robot don´t offers real patient benefits in terms of surgical outcomes ØMain advantage of robotic surgery the learning curve and quality of the suture (surgical stitches) when compared to laparoscopy ØMain indications for robotic surgery: - Partial nephrectomy, - Retzius-sparing prostatectomy, - Cystectomy with urinary diversion performed intracorporeally, - Kidney transplantation

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Future perspectives Robotic surgery continues to evolve into newer techniques and refine the past techniques.

Departamento de Urologia – CUF Tratamos Ensinamos Descobrimos Robotic surgery in urology European perspective Estevao Lima 2017