Robotic surgery

What is robotic surgery?

Robotic surgery is a kind of keyhole (minimally invasive) surgery. The surgeon does not put their hands inside the patient. Instead, they sit at a console nearby and control thin instruments that are placed through small cuts in the abdomen.

A small camera goes in too, and gives a three-dimensional view of the operating area, magnified about ten times. As the surgeon moves the hand controls, the instruments inside the patient copy those movements very precisely.

Why robotic surgery is used

Compared to traditional open surgery (one big cut), the robotic approach offers several features that suit deep, delicate areas of the body, such as the prostate or kidney:

• 10 times magnification of what the surgeon can see.
• A three-dimensional view, like an IMAX cinema, instead of a flat one.
• Robotic wrists with more degrees of movement than the human wrist, so instruments can rotate around tight corners.
• Gas pressure inside the abdomen helps reduce bleeding from small veins during the operation.

For patients, the typical practical benefits are smaller scars, less pain after the operation, less time in hospital, and a faster return to normal life than with open surgery. The surgical steps and the goals of the operation (for example, removing a cancer cleanly, or rebuilding a kidney drainage tube) are exactly the same.

What it is used for at Urology NSW

Dr Kooner uses the robot for a number of urological operations, including:

• Robotic prostatectomy - removing the prostate for prostate cancer.
• Robotic pyeloplasty - rebuilding the kidney drainage where it is blocked.
• Robotic adrenalectomy - removing one of the adrenal glands when it has a tumour.
• Robotic kidney surgery - removing a tumour while keeping as much of the kidney as possible.

Dr Kooner has a long history of robotic surgery in Australia, including the first robot-assisted radical prostatectomy in NSW, and the first robot-assisted adrenalectomy and kidney cancer operation in Australia.

What it is not

Robotic surgery is sometimes called "the robot doing the operation". This is not how it works. The robot does not move on its own. It only does what the surgeon tells it to do, in real time, through the hand controls. The skill, judgement, and experience of the surgeon are still the most important factors in the result.

For that reason, what matters most when you are choosing surgery is not just whether it is robotic, but who is doing it, and what their own results look like.