What is Robotic Surgery?

Robotic surgery is a type of minimally invasive surgery. Minimally invasive surgery reduces the incision size by using miniaturised surgical instruments. Operations performed using the Robotic surgical system offer surgeons unprecedented control over the minimally invasive environment resulting in less trauma to the patient, with minimal scaring, faster recovery times and for prostate cancer patients less incontinence and a faster return of the sexual function.

why bother with robotic surgery? is it better than open surgery?

Historically, all surgery used to be performed via large cuts (incisions) through the skin and muscles to provide ‘opening’ through which surgeons and their assistants could shine light, see and place their hands and instruments to perform complex operations on the internal organs.

In the 1990s, surgery entered a revolutionary new era of ‘minimally invasive surgery or “keyhole” surgery whereby surgeons learnt to perform surgery via a few tiny ‘keyhole’ sized incisions, rather than large ‘open’ incisions.

This resulted in less pain and faster recovery, however the most complex major operations were considered “too difficult” for simple keyhole surgery, due to the limitations of the 2D vision and surgical equipment at the time which was inferior to the movements of the human hand with open surgery. Most major operations were therefore still performed via a large open incision.

A decade ago, a second revolution occurred with the invention of robotic surgery. The Da Vinci Robot essentially allows 3 miniature keyhole instruments (each with better manoeuvrability than a human hand, less tremor and around 15x smaller than a human hand) to work deep inside the confined spaces of the body that are too small for the human hand to work properly, for example in the pelvis where the prostate and bladder are situated.

Robotic-assisted surgery has completely revolutionised surgery for prostate, bladder and kidney cancer. It has been scientifically proven to result in:

• less post-operative pain

• Shorter hospital stay, faster return home sooner

• Faster return to normal activities such as work and exercise

• Less blood loss

• Less blood transfusions

• Less anastomotic strictures (blockages)

• Less injuries to surrounding organs eg rectum

• Less wound complications (infections, hernias, dehiscence)

In prostate cancer surgery, there are very important advantages when performed a surgeon such as myself, who is experienced in and has sub-speciality training in robotic prostate cancer surgery (as proven in our large research studies published in 2014 and 2018 in European Urology, the world’s most prestigious urology journal):

• Earlier return of urinary control (continence) meaning less time wearing pads

• Improved return of sexual function (erections)

• Improved urinary symptoms

• Better cancer control (via lower positive surgical margin rates)

• less risk of cancer recurrence (called biochemical recurrence).

Not all operations require robotic surgery, for example simple kidney removals are easily done via traditional keyhole laparoscopic surgery thus saving costs to the patient and health system. And some operations are still too complex for robotic surgery, for example where there has been many previous operations resulting in extensive scar tissue within the abdomen or where the size or location of a cancer makes keyhole surgery impossible. The majority of cases, however, are suitable for a robotic approach.

I have dedicated my life to providing world class cancer care including robotic surgery for prostate, bladder and kidney cancer to all patients under my care, at an affordable and reasonable cost. For those who do not have private health insurance, I am fully trained in open and laparoscopic keyhole surgery which I can provide via the public hospital system.

I am also working with the NSW South Eastern Sydney Area Health Service towards universal access for all public patients to robotic surgery in the near term.

Choosing a robotic surgeon

Robotic surgery, in the right hands, can offer patients many benefits including quicker recovery, less complications, less incontinence and better sexual outcomes. As with all new technologies, and surgical advancements, a surgeon undertakes a period of learning where patients outcomes may only be equal to that of traditional open surgical techniques. Research suggests patient receive better outcomes only when their surgeon has performed over 100 surgeries of that particular kind.

Following a two-year Robotic Fellowship at the prestigious University College London Hospital, Dr Thompson has performed over 500 major robotic and open operations to remove prostate, bladder and kidney tumours. He regularly performs the most complex operations that other urologists are unable to perform such as salvage surgery after radiotherapy, robotic bladder removal with robotic creation of a new bladder, bladder augmentation cystoplasty using intestine, etc.

Patients should feel comfortable and are encouraged to ask their surgeon how many surgeries of this kind have they performed using the robotic surgical system. Furthermore, patients should feel comfortable asking their surgeon about out of pocket expenses.

What conditions can be treated robotically?

Common urological conditions treated using the robotic surgery include prostate, bladder and kidney cancers. Not all patients are a candidate for robotic surgery and not all patients require surgery to effectively treat their cancer. Upon consultation with Dr Thompson, a treatment plan will be devised….

Further Resources

See the most recent guidelines from the European Association of Urology (EAU) on Prostate Cancer. This guideline document is prepared to assist medical professionals in the evidence-based management of Prostate Cancer.

https://uroweb.org/guideline/prostate-cancer/