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Slide 1-

Robotic Surgery in Reconstructive Urology Joseph Costa, DO Interim Chairman, Department of Urology Associate Professor of Surgery University of Florida College of Medicine-Jacksonville
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Evolution of Surgical Technique Open surgical Laparoscopic Robotically assisted
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www.emedicinehealth.com Amila Ratnayake 2013
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J Urol. 1991 Aug;146(2):278-82.
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Laparoscopic Approach http://www.devasyahospital.com/laparoscopic-nephrectomy/
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2 year experience Laparoscopic nephrectomy, single institution experience N = 24 Greater mean operative time (6-7 hrs) Hospital stay 4 days Return to activity 3.4 weeks Return to work 6 weeks Br J Urol. 1994 Mar;73(3):231-6
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Abbou, et al. 2001
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Early Adoption Laparoscopic approach was superior for recovery, however, a tremendous learning curve existed for reconstructive techniques Purely laparoscopic surgery did not allow wristed joint articulation Purely laparoscopic surgery does not allow 3 dimensional visualization , depth perception is problematic Procedures intensive in suturing require wristed motion Try signing your name in cursive with a mouse adobe
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November 2003 Volume 170 (5): 1738-41.
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J Urol 174, 269-272, July 2005
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Adoption of Robotic Prostatectomy
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Evolution of reconstruction Oncology lead initial adoption Minimal reconstruction in oncologic procedures with exception of prostatectomy Nephrectomy, Colectomy, Hysterectomy, Cholecystectomy adopted early as ideal cases for laparoscopic approach Prostatectomy adopted more widely only after adaptation to Robotic assisted approach
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Urology. 2016 Aug;94:123-8.
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Richstone L, Scherr D. http://abdominalkey.com/robotic-and-laparoscopic-bladder-surgery/
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Urology. 2016 Aug;94:123-8.
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Open vs. MIS approach: Adult Ureteral Reimplantation Urology. 2016 Aug;94:123-8.
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Vaginal Prolapse Repair Multi-Center study , N = 78 (38 Lap, 40 Robot) 97-100% subjective improvement Significant improvement in validated questionnaires 3 Reoperative cases for bowel complications Female Pelvic Med Reconstr Surg. 2016 ; 22(5): 382–384.
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Obstet Gynecol Sci. 2016 Jul;59(4):253-260.
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579 × 306 - urobriz.com.au http://urology.jhu.edu/MIS/lap_pyeloplasty.php.
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Ellsworth P, Kim E. eMedicine 2016
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daVinci ©
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daVinci ©
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Cent European J Urol. 2016; 69: 217-220
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Ileal Ureteral Interposition Chronic stent exchange Nephrectomy Korean J Urol. 2014 Nov;55(11):742-749. Intl J Braz Urol. Vol. 38 (6): 779-787, November - December, 2012
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Dielubanza et al. TAU, Vol 3, No.2 June 2014
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Korean J Urol. 2015 Jul;56(7):478-486
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Cent European J Urol. 2016; 69: 217-220
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Evolution of reconstruction First extirpation procedures lead the way Simple reconstruction (e.g. Prostatectomy) More complex reconstruction Abdominal Sacrocolpopexy Pyeloplasty Distal ureteral reimplantation Very complex reconstruction Long ureteral length reconstruction
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Non-Prime Time, Future Practice Bowel reconstruction or urinary diversion Tissue transfer techniques
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Thank You