Robotic Urology Surgery

What is robotic surgery?

Robotic surgery in Urology involves the use of the daVinci Xi robotic surgical system. The robot operates under the direct control of Dr Handmer, and doesn’t move or make decisions itself unless directly commanded.

The robot provides 3D magnified vision, precise control of highly dexterous instruments and works through ‘ports’ which are placed  usually into the abdomen.

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The robot can be used to perform many different procedures.

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Rather than a specific procedure, you can think of the robot as a surgical tool – a very complicated tool – that can be used to achieve many different outcomes.

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For example, in Newcastle, Dr Handmer frequently performs the following robotic procedures:

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• Robotic prostatectomy (aka robot prostate, robotic radical prostatectomy, RALP, RARP)

  • Where the prostate is removed with a surgical robot under the control of Dr Handmer, usually for prostate cancer, but sometimes for other conditions as well

• Robotic partial nephrectomy

  • Where part of the kidney is removed with the surgical robot, usually for suspected cancer or an abnormal growth on the kidney

• Robotic nephroureterectomy

  • Where the kidney, and the ureter are removed together with the surgical robot, usually for cancer

• Robotic pyeloplasty

  • Where the drainage system of the kidney is divided and re-joined using the surgical robot, usually to treat obstruction caused by PUJ obstruction (known as UPJ obstruction in some countries overseas)

• Robotic cystectomy

  • Where the bladder is removed with the surgical robot (and sometimes the prostate/uterus/ovaries), in most cases, to treat advanced bladder cancer
     

How is robotic surgery different to keyhole surgery?

Robotic surgery is a form of keyhole ‘laparoscopic’ surgery and has all of the advantages of traditional keyhole surgery. Unlike pure laparoscopic surgery, the robotic instruments have tiny ‘wrists’ and are in the control of movable, very precise robot arms which act under the control of Dr Handmer, who can see the operative area in three dimensions.

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What is recovery after robotic surgery like?

Almost all studies of robotic surgery in Urology demonstrate faster recovery, and a shorter time in hospital after surgery. Most studies show patients have less pain after robotic surgery. Of course, robotic surgery is still major surgery, and complications of major surgery can be unpredictable and significant.
 

However, you won’t be discharged before you are ready, and Dr Handmer will explain to you prior to, and after the operation, what your expected time in hospital (usually Lake Macquarie Private Hospital or Lingard Hospital, where both robotics in Newcastle NSW are located) will be, as there are many other things that can affect this.
 

What are the benefits of robotic surgery?

In addition to the typical benefits of a shorter length of stay in hospital and reduced postoperative pain, in the scientific literature, robotic surgery consistently has lower (or comparable) rates of major and minor complications to existing keyhole ‘laparoscopic’ and open surgery.
 

Some of these benefits identified in studies include: Lower rates of transfusion, lower risk of wound complications and infections, lower risk of urine leak into the abdomen.
 

There are some studies, including Australian studies, suggesting that robotic surgery may be associated with improved cancer outcomes (for example, reduced positive surgical margin rates with robotic vs open radical prostatectomy).
 

What are the risks of robotic surgery?

In the scientific literature, robotic surgery is consistently found to be as safe, or safer than traditional keyhole and open operations.
 

However, there are some specific risks to robotic surgery. These include risks of fluid swelling to the head, eyes and breathing tube with some patient positions. Your anaesthetist will assess your safety for surgery from a heart and lung perspective, including considerations such as positioning. Dr Handmer works with regular anaesthetists who routinely, and safely, anaesthetise patients for robotic procedures.
 

There is also the risk of robot device failure. This is extremely unusual as the robot has many in built backups (redundancies). However, in the unlikely event that the robot was to cease functioning during a procedure, if critical steps of the operation had already occurred, your surgery would be continued with traditional keyhole or open surgery, which Dr Handmer is also trained in.

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Do I need to see a Urologist who performs robotic procedures?

In many cases, Dr Handmer sees patients who are referred by another Urologist who doesn't perform robotic surgery at all, or doesn't perform the specific type of robotic surgery that is being considered or recommended (for example, robotic radical prostatectomy).

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Although all Urologists have training in performing the initial assessment and management of patients with just about every possible Urological problem, most Urologists don't routinely perform every possible Urological procedure in their practices, instead, they tend to subspecialise. This is because training, experience and case volume are all important in achieving quality outcomes, and it is simply not possible to be an expert in everything. 

 

For this reason, in cases where a robotic procedure may be indicated, but your Urologist may not offer that specific operation, or desires a second opinion, you may be referred for an opinion from Dr Handmer.​ 

 

For exactly the same reason, Dr Handmer routinely refers patients with certain subspeciality conditions to other colleague Urologists who, in turn, specialise in those areas. 

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Further information

Please discuss your specific medical condition with Dr Handmer or his staff. Please see further information about referrals above.