Robot-Assisted Surgery Has Advantages for Kidney Surgery

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Robot-assisted surgery found to be faster and less bloody when compared to laparoscopic surgery for repairing kidney blockages that prevent urine from draining normally to the bladder. Patients who had robot-assisted surgery also had shorter hospital stays.

Ashok Hemal, M.D., a urologic surgeon from Wake Forest University Baptist Medical Center, published the results of his study in the February issue of Canadian Journal of Urology. The single-surgeon, single-center study compared laparoscopic and robot-assisted surgery for repairing uretero-pelvic junction obstruction. Patients were followed for 18 months.

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The study involved 60 patients who had a procedure known as pyeloplasty which involves reconstructing the narrow area where part of the kidney meets the ureter (the tube that carries the urine from the renal pelvis into the bladder). Blockages at the uretero-pelvic junction can be the result of birth defects or, in adults, from injury, previous surgery or disorders that can cause inflammation of the upper urinary tract.

Hemal treated 30 patients with laparoscopic surgery and 30 with robot-assisted surgery. Laparoscopic surgery uses a minimally invasive approach that requires only small incisions in which the surgeon directly manipulates a viewing device and operating instruments inserted into the abdomen. Robot-assisted surgery, also minimally invasive surgery using small incisions is done with the surgeon sitting at a console and using this hand and finger movements to control centimeter-size instruments while viewing the surgical site on a screen.

Both surgeries were found to be equal in correcting the obstruction. Robot-assisted surgery was found superior in three ways. On average, robot-assisted surgery was 50% faster (98-minute versus 145-minute average), resulted in 60% less blood loss (40ml versus 101ml average), and required a two-day hospital stay, versus 3.5 days for laparoscopic surgery.

"The evolution of laparoscopic surgery in urology has been limited because it is technically challenging and requires the surgeon to be proficient in advanced suturing," said Hemal. "Robot-assisted surgery offers a way of overcoming some of the major impediments of laparoscopic surgery. This study shows the two options are equally effective and that robot-assisted surgery has several advantages."

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