Urology

Urology

Urology is among the medical fields with the highest rate of technological advancements, including the use of robotic surgery. The da Vinci system is the robotic platform that has taken minimal invasive surgery one step further making possible advanced delicate procedures, with ease.

Applications of robotics in urology are:

  • Radical prostatectomy preserving the erectile nerves and thus avoiding the loss of erectile function (over 95%)
  • Cystectomy and formation a neocyst in the place of the old one
  • Radical or partial nephrectomy
  • Retroperitoneal lymph node dissection
  • Inguinal lymph node dissection
  • Pyeloplasty
  • Nephrouretectomy
  • Removal of stones from the ureter, of lymph nodes and of renal cysts
  • Varicocele repair

Robotic Prostatectomy

Robotic prostatectomy for prostate cancer is considered a gold standard treatment option in urology. It has been shown that with the application of robotic prostatectomy, the oncological and functional results are better than all other types of radical prostatectomy.

The anatomical position of the prostate in the male body is such that its radical removal is not a simple case. Thus, this surgery requires a careful preparation of the prostate to avoid the damage of the nerves for erectile function and other surgical margins.

One of the most popular methods of prostatectomy, to date, is classic open surgery, (which requires a few cm.).

Conventional, “open” prostatectomy, often causes massive blood loss and requires prolonged recovery time and return to normal activity.

Today, Robotic Assisted Laparoscopic Radical Prostatectomy is a state of the art surgery using da Vinci technology for radical removal the prostate in a minimally invasive way.

With robotic prostatectomy, oncological procedures on difficult-to-access areas of the abdomen are carried out very accurately and with the best possible functional results.

The prostate is a walnut-sized gland in men, located just below the bladder and in front of the rectum, surrounding the urethra (the tube through which urine is transferred out of the bladder). Its main function is to produce and store (in the seminal vesicles) fluid that contributes to semen formation. Prostate cancer is characterized by uncontrolled (malignant) growth of prostatic cells in the gland and is the second-leading cause of cancer death in men, following lung cancer.

Robotic radical prostatectomy, applied to treat prostate cancer has been, for many years now, the most frequent robotic surgery performed worldwide. During the procedure, the surgeon removes the whole prostate gland in order to relieve the patient from cancer while meticulously dissecting around the surrounding structures and nerves, thus offering a high probability of continence (urinary control) and potency (sexual function preservation).

With the robotic, da Vinci surgical system, the surgeon has the ability to protect the erectile nerves surrounding the gland, thanks to the large magnification and three-dimensional imaging provided by the machine.

At the same time, the freedom of movement of robotic surgical instruments allows for a more detailed anastomosis between the bladder and the urethra.

Robotic Assisted Laparoscopic Radical Prostatectomy has the same oncological effects as open prostatectomy, but it is superior in many aspects such as:

  • The smallest post-operative pain
  • Less use of analgesia
  • Faster removal of the catheter
  • Fewer days spent in the hospital
  • Faster return to daily activities
  • Less blood loss
  • Better control of continence
  • Better erectile function

 

The NeuroSAFE technique

Robotic radical prostatectomy, with the use of the DaVinci Xi system, available at AMG’s hospitals, is the best treatment option for localized and locally advanced prostate cancer. Its superiority lies not only in the oncological outcome but also in optimally maintaining erection and urinary continence, as well as reducing or even eliminating postoperative complications.

With the robotic system’s help and according to the European guidelines, the surgeon is now able to proceed with a higher degree preservation of the neurovascular bundle, ensuring the treatment of the disease.  In the past this was not possible for patients with extensive or aggressive disease, and the surgeon was compelled not to proceed to nerve spare radical prostatectomy, thus harming the nerves and blood vessels of erection and continence, which are attached to the prostate.

Furthermore, the innovative NeuroSAFE technique allows the “introduction” of the microscope in surgery, so that the surgeon can decide, before the completion of the operation, if the nerves should be preserved, as they may have been affected by the disease at a microscopic level. The surgeon removes the prostate through a specially shaped incision, with no need to remove the robotic system from the patient. Then, in collaboration with the pathologist, the surgeon examines the prostate areas where neurovascular bundle has been detached and fully preserved, in order to ensure the ideal oncological outcome.

Bladder Cancer

Bladder cancer accounts for the 3% of all malignancies and is one of the most common tumors in urology. Until recently, bladder cancer was treated with classical open surgery, performing a long incision in the abdomen.

Today, with the contribution of modern technology and, in particular, the assistance of the da Vinci robotic system, it is feasible to carry out radical bladder removal and to form a new bladder as a substitute to the old one, through very small incisions in the abdomen.

The da Vinci system increases surgical capabilities by allowing complicated and delicate operations, thanks its unique advantages, such as the magnification of the surgical field and the three-dimensional (stereoscopic) vision.

It should be noted that this robotic cystectomy method is performed successfully in a small number of hospitals worldwide.

The most important advantages of robotic da Vinci radical cystectomy are:

  • Intervention with very small incisions
  • Short stay at the hospital (4-5 days)
  • Minimal pain
  • Reduced likelihood of infection
  • Minimal blood loss and very low transfusion rates
  • Fast recovery from surgery
  • Fast return to normal activity
  • Equal oncological effects to that of classical surgery
  • Diversion of urine
  • Preservation of erectile function

 

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