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 May 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.
