Robotic Surgery Archives

Robotic Urinary Diversion Ilial Conduit

by Janet B. Kukreja, MD, MPH, FACS | Jan 2025

Janet B. Kukreja, MD, MPH, FACS, provides a detailed overview of performing robotic-assisted ileal conduit surgery, focusing on practical techniques and strategies for effective urinary diversion.

In this 12-minute presentation, Dr. Kukreja shares a video of one of her procedures, beginning with port placement and tool selection. Using both handheld and robotic staplers, she demonstrates methods to minimize complications and ensure precision during bowel anastomosis. She discusses techniques to avoid complications, such as meticulous ureter preparation, vascular supply preservation, and strategic suture placement. The demonstration covers methods for managing the ureters, including tunneling under the sigmoid and spatulating to ensure optimal flow and reduce the risk of narrowing.
This comprehensive overview provides practical insights into optimizing robotic urinary diversion procedures, making it a valuable guide for surgeons managing complex cases requiring ileal conduits.

Alternative Access Approaches for Less-invasive Nephron-sparing Surgery

by Richard E. Link, MD, PhD | Jan 2025

Richard E. Link, MD, PhD, explores advances in robotic kidney surgery, focusing on nephron-sparing approaches and alternative access strategies, specifically through the low anterior access with the SP (single-port) robot. Historically, while only about 10% of nephron-sparing surgeries employed the retroperitoneal technique due to challenges in positioning and multiport access, the advent of the SP robot has significantly altered this landscape.

In this 18-minute presentation, Dr. Link shares the low anterior access technique, which offers a versatile approach to addressing tumors located anywhere in the kidney—anterior, posterior, medial, or lateral—while minimizing the need for complex patient positioning. The primary advantage of this approach is reduced postoperative complications, faster recovery, and less pain, which are of greater importance to patients.

Data from Link’s practice indicate a marked increase in adopting retroperitoneal access using the SP robot, rising from 15% to 80% over recent years. This shift has led to a significant reduction in hospital stays and a streamlined surgical process, resulting in shorter operative times. Dr. Link shares video of the process and includes practical tips for optimizing this approach.

KEYNOTE LECTURE – Introduction of Disruptive Technologies The Lessons From the Minimally Invasive Surgery

by Ralph V. Clayman, MD | Dec 2024

Ralph V. Clayman, MD, offers an inspiring and pragmatic perspective on fostering innovation and navigating the challenges of medical advancements. He begins this 34-minute keynote presentation by emphasizing the importance of curiosity and intellectual humility.

Dr. Clayman underscores how disruptive technologies have evolved in urology by presenting historical examples. He traces the creative and collaborative processes that turned initial skepticism into groundbreaking techniques, emphasizing the philosophical, practical, and personal factors required to drive innovation. These include having a clear vision, protected time, effective partnerships, and a multidisciplinary team.

Clayman discusses the future intersection of robotics and artificial intelligence, foreseeing advancements like automated anastomoses and enhanced focal therapies. He stresses that meaningful progress will require collaboration, resourcefulness, and a willingness to challenge conventional norms. He offers practical advice for aspiring innovators and recommends building diverse teams with complementary strengths, as innovation is inherently collaborative.

Robotic Pyeloplasty in 2024: Technical Considerations and Approaches

by David M. Strauss, MD | Dec 2024

David M. Strauss, MD, focuses on robotic pyeloplasty and highlights its role in managing ureteropelvic junction (UPJ) obstruction through various surgical techniques and approaches.

In this 9-minute presentation, Dr. Strauss shows videos of both transecting and non-transecting approaches. He details positioning and access for robotic surgery, emphasizing replicating setups similar to nephrectomy and using a combination of robotic arms. He notes the flexibility of surgical platforms, including transperitoneal and retroperitoneal approaches.

Strauss underlines the durability of pyeloplasty, the importance of individualized patient care, and the value of mastering multiple surgical approaches to optimize outcomes.

Robotic GU Fistula Repair

by Divya Ajay, MD, MPH | Sep 2024

Divya Ajay, MD, MPH, covers diagnosing and managing genitourinary (GU) fistulas, emphasizing the complexity and challenges involved. Fistulas can occur throughout the urinary system, affecting the lower and upper tracts. Common causes include gynecological surgeries, cancer treatments, radiation, and infections.

In this 24-minute presentation, Dr. Ajay discusses vesicovaginal, urethral, and colovesical fistulas, with treatment strategies varying based on fistula type and patient condition. Ajay shares several surgical approaches, including robotic, vaginal, and open surgeries, tailored to the fistula’s location and severity. Ultimately, successful outcomes depend on precise diagnosis, appropriate surgical technique, and postoperative management.

Tips and Tricks for Robotic Ileal Ureter

by Ziho Lee, MD | Sep 2024

Ziho Lee, MD, provides insights into robotic ileal ureter reconstruction, offering practical strategies for optimizing outcomes.

In this 10-minute presentation, Dr. Lee uses photos and procedure videos to outline an effective surgical strategy, starting with proximal ureter dissection to assess feasibility, followed by bowel harvest, bladder preparation, and distal anastomosis. Proper exposure is stressed as critical to ensure the best outcomes. Port placement strategies are discussed, including single setup configurations and rotating the robotic boom for upper tract access. Various tunneling techniques are detailed, including creating a mesenteric window to reduce strain and ensure smooth passage of the ileal segment.
The presentation concludes by emphasizing the importance of meticulous technique and thorough planning, especially for patients with complex histories, including prior pelvic radiation. While the indications for ileal ureter replacement are decreasing, it remains a vital tool for urologists. With careful patient selection and precise execution, surgical success rates can reach 90%, minimizing the need for future interventions.

IFRUU Innovations

by Fernando J. Kim, MD, MBA, FACS | Sep 2024

Fernando J. Kim, MD, MBA, FACS, focuses on innovations and emerging technologies in functional urology. In this 14-minute presentation, he highlights recent advancements in areas like 3D printing, robotics, and telemedicine, emphasizing their potential to transform clinical practice.

Margin Call: Focal vs. Regional Ablation

by Preston C. Sprenkle, MD | Aug 2024

Preston C. Sprenkle, MD, analyzes focal versus regional ablation in prostate cancer treatment, examining the nuances and outcomes associated with each approach. His discussion centers on the effectiveness, risks, and clinical decision-making processes involved in choosing between these two strategies.

Dr. Sprenkle highlights the advantages of focal ablation, including reduced side effects, such as urinary incontinence and erectile dysfunction. Dr. Sprenkle also discusses the potential benefits of regional ablation, particularly in patients with multifocal or higher-risk disease.

Multiparametric MRI (mpMRI) and targeted biopsies play crucial roles in mapping the extent of the disease and guiding the ablation strategy. Dr. Sprenkle underscores the need for a personalized approach, considering factors such as tumor size, location, Gleason score, and patient comorbidities. The discussion also covers the technical aspects and outcomes of both ablation techniques, with data on success rates, complications, and long-term efficacy.

Dr. Sprenkle highlights future directions in prostate cancer ablation, including advancements in imaging, robotic assistance, and the integration of novel therapeutic agents to enhance precision and effectiveness.

Obstacles to Optimal Outcomes for Patients Undergoing Radical Cystectomy

by Raj S. Pruthi, MD, MHA, FACS | Aug 2024

Dr. Raj S. Pruthi discusses the obstacles to achieving optimal outcomes for patients undergoing radical cystectomy. He meticulously analyzes the multifaceted challenges encountered in the preoperative, intraoperative, and postoperative phases of radical cystectomy, a complex surgical procedure primarily performed for muscle-invasive bladder cancer.

Preoperative factors that can impede optimal outcomes, including patient comorbidities, nutritional status, and the importance of thorough preoperative assessment and optimization. He emphasizes the role of prehabilitation in enhancing patient readiness for surgery.

During the intraoperative phase, Dr. Pruthi highlights the technical intricacies of radical cystectomy, stressing the importance of surgical expertise and meticulous technique in minimizing perioperative complications. He discusses the role of minimally invasive techniques, such as robotic-assisted surgery, in potentially reducing blood loss, shortening hospital stays, and enhancing recovery.

Postoperatively, Dr. Pruthi identifies key factors that influence recovery and long-term outcomes. He underscores the significance of effective pain management, early mobilization, and comprehensive postoperative care in mitigating complications. Dr. Pruthi also discusses the challenges related to urinary diversion, including the management of neobladder and ileal conduit complications, and the impact of these diversions on patients’ quality of life.