How to cite: Link, Richard E. “Navigating the Shifting Landscape of Minimally Invasive Urologic Surgery in the Era of Single Site Robotics.” September 2023. Accessed Jul 2024. https://grandroundsinurology.com/navigating-the-shifting-landscape-of-minimally-invasive-urologic-surgery-in-the-era-of-single-site-robotics/
Navigating the Shifting Landscape of Minimally Invasive Urologic Surgery in the Era of Single Site Robotics – Summary
Richard E. Link, MD, PhD, discusses the shifting landscape of minimally invasive urologic surgery in the era of single-site robotics. He describes the state of urologic minimally invasive surgery as a “messy toolbox,” with a huge diversity of technologies and techniques currently employed and a lack of consensus.
Dr. Link then ranks approaches based on invasiveness, with robotic single-port (SP) systems being the least invasive. He outlines benefits and drawbacks of various techniques and wonders if there has been a period of stagnation.
He then addresses advantages of the da Vinci SP system, with a softball-sized working envelope and a 360-degree rotation around its axis, its robotic dexterity, its ability to work through small incisions (2.7 cm), and its versatility for multi-quadrant surgery, as well as in working with extraperitoneal, retroperitoneal, and transvesical approaches. He lists disadvantages as well, including cost, scarcity, learning curve, and challenges with large specimens.
Dr. Link contends that development of the SP approach is driving an increase in extraperitoneal approaches (while laparoscopic and robotic advancements drove towards the transperitoneal approaches). He then explains the shift towards the retroperitoneal approach, which is more efficient and timesaving. Dr. Link lists anesthesia advantages of SP, including shorter procedures, lower risk of abdominal entry vascular and organ complications, less pain, and fewer incisions.
Dr. Link then explains that today the SP comprises the vast majority of his radical prostatectomies. He describes the new technology interplay between cost/availability, skills/training, patient benefits, and versatility/speed and acknowledges the tension between a new platform and a technique with which a practitioner is comfortable. Dr. Link predicts that costs will drop, availability will rise, and calls SP “the future.”
About The 27th Annual Innovations in Urologic Practice:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma; men’s health topics like male infertility, andrology, and sexual dysfunction; OAB and voiding dysfunctions; and ways to diagnose and treat infections in the urology patient.
For further educational activities from this conference, visit our collection page.
ABOUT THE AUTHOR
Richard E. Link, MD, PhD, is a professor and board-certified and fellowship-trained urologist specializing in the treatment of urologic disease affecting the kidney, ureter, adrenal gland and prostate. Dr. Link holds the Carlton-Smith Endowed Chair in urologic education at the Baylor College of Medicine (BCM) in Houston, Texas and directs the BCM division of endourology and minimally invasive surgery. He serves as director of living donor procurement for several major kidney transplant programs in Houston, including Baylor St. Luke’s Medical Center, Texas Children’s Hospital, and the Houston Methodist Hospital. Dr. Link focuses on the use of laparoscopic, robotic-assisted, percutaneous, and endoscopic techniques to treat kidney and prostate tumors, benign prostatic hypertrophy, renal and ureteral obstruction, and urinary tract stones and has been an early pioneer in the development of laparoendoscopic single-site donor nephrectomy.
Dr. Link earned both his MD and PhD in molecular and cellular physiology at Stanford University in California and completed an internship and residency at BCM before completing a fellowship at The Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Link also has a strong interest in applying single site robotic technology using the da Vinci SP platform to retroperitoneal and transvesical urologic surgery. He has published numerous papers and earned many awards, including the Fulbright and Jaworski LLP Faculty Excellence Award for Teaching and Evaluation at BCM.
