Robot-Assisted Radical Cystectomy

What is a robot-assisted radical cystectomy?

Like any surgery, robot-assisted radical cystectomy (RARC) takes place in an operating room that has been specially prepared for the procedure. The striking difference is that the surgeon is not at the operating table. Instead, the surgeon sits at a high-tech station nearby, looking through a special viewer that displays a high-definition, 3-dimensional, magnified picture from the camera arm of the robotic device. The surgeon’s hands and feet operate controls that function somewhat like joy-sticks, only much more sensitive and complicated. These controls translate the surgeon’s movements to the robotic device and allow it to make the intricate, precise movements needed for this complex surgery.

At the operating table are specially-trained surgical assistants that monitor the patient, change the tools on the robotic arms, and assist the surgeon to make sure that everything goes smoothly. They have computer monitors that allow them to see what the surgeon sees, and microphones so they and the surgeon can communicate.

Several small incisions (cuts), only about one-half inch wide, are made in the abdomen, and the machine’s slender arms fit through these holes into the abdominal cavity. One of the machine’s arms has a high-resolution video camera that shows the surgeon and the assistants the area inside the abdomen where they are working. Three other arms work like extensions of the surgeon’s hands. When the surgeon moves the controls at the console, the tiny precision tools on the ends of these arms perform the actions that correspond to these movements. These arms have mechanical wrists that are even more flexible than the human wrist, and small tools for cutting, pulling aside tissue, and suturing (sewing). Because the tools are so small, they can make more precise movements than the human hand. It takes a lot of training and practice for a surgeon to master these techniques.

Robot-assisted Versus Open Surgery

Our study comparing simple laparoscopy with robot-assisted surgery showed that the tasks performed by surgeons with robotic assistance were easier and quicker. It also showed that the tiny wrist of the robot and magnified vision (10x magnification) gave significant advantage to the surgeon in operating in narrow spaces such as the prostate, bladder and uterus.

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Surgical Proficiency

Radical cystectomy is a very complicated operation. The entire procedure takes a little more than six hours. Operative time depends in part on the type of urinary diversion being done—this is the part of the procedure in which a new system for collecting urine and removing it from the body is created. Other things that affect how long the operation takes include the patient’s particular anatomy, skills and experience of the surgeon and the team.

Roswell Park partnered with 21 surgeons across the globe to evaluate the learning curve or how many cases are needed to reach a basic level of proficiency to safely perform the procedure. This study, published in European Urology in 2010, revealed to reach an acceptable level of proficiency, a surgeon should have performed at least 30 of such procedures. Roswell Park surgeons have performed over 800 such procedures since 2005.

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Surgical Experience

Previous experience with robot-assisted surgery is also critical in obtaining better results. A study published in the Urology Journal in 2010 revealed that previous experience with robot-assisted surgery affects the time taken to operate, blood loss and the number of lymph nodes obtained.

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