Surgery is an art based on scientific principles that deals with curing the disease by removing or repairing a diseased organ by operating on it. Susrutha is known as father of surgery.

with the evolution and development of anaesthesia (art of putting a person in deep sleep) and knowledge of human anatomy, surgery gained popularity and its now a commonly used method to treat a disease in modern medical science.

Open surgery requires cuts on the surface of body to reach into deeper parts of body. Minimally invasive surgery or keyhole surgery is a modern surgical technique in which operations are done by making small cuts on the surface of body to introduce instruments into deeper parts and avoid big cuts (incisions) on the surface of body.

Laparoscopic surgery is a type of keyhole surgery started gaining popularity in 1990’s with advancements in optics (camera and light cables and 3-dimensional vision), refinement in surgical instruments with more flexibility and better energy devices robotic surgery entered slowly in India by 2010’s. Initially used widely in pelvic surgeries like prostate, uterus and colon, now the scope of uses has widened to other surgeries also.

Robotic surgery or robot assisted surgery is a kind of minimally invasive surgery, where robotic arms enter the human body through small keyholes to perform the surgery. These arms are controlled by a surgeon sitting at a distance on a console.

Uro-oncology is a sub speciality of urology that deals with cancers of genito-urinary system, that includes Kidneys, ureter, urinary bladder, prostate, urethra, penis, testicles and adrenal gland.

Robotic Surgery and Prostate Cancer

Robotic surgery has revolutionized the treatment of prostate cancer. Due to rising awareness, routine health checkups and better availability of healthcare facilities at one end and because of increased life span and large number of ageing populations now prostate cancer cases are diagnosed more commonly and that’s why the number of prostate cancer cases are increasing rapidly. It is also important to note that, now more prostate cancers are diagnosed in the early stages.

Early cases of prostate cancers are curable by surgically removing the prostate gland completely. This surgery is a challenging surgery for most of the urologists as to remove the prostate from deep pelvis and then reconstruct the normal urinary passage requires a great skill and experience. Urinary incontinence and impotency are common side effects of this surgery. Robotic surgery appears to be the perfect solution for these problems, it makes the access to prostate easier, nerve sparing surgery can be done to preserve the potency, there is minimal scar, minimal pain, minimal blood loss.

Robotic Surgery and Kidney Cancer

Kidney cancers and cysts are commonly seen now a days as incidental findings on abdominal ultra-sonographies done for unrelated causes. Most of them are small in size and do not have any symptoms. Some of the kidney tumours may present with passing of blood in urine. Earlier we used to remove the kidney along with the tumor for many patients. Now many of these tumours can be removed preserving the normal kidney (Nephron Spearing Surgery). Robotic surgery has great advantages for this surgery as the cutting of the tumour and repair of the rest of kidney is much easier by robotic instruments and this is done with minimal scar on body. Advanced kidney cancer cases with extension into large blood vessels can also be managed effectively by robotic surgery.

Urinary Bladder Cancer patient sometimes require removal of urinary bladder. Robotic surgery is slowly gaining popularity for this procedure, reconstruction of new urinary passage requires lot skills and this surgery should be done only in high volume centres for better outcome. Artificial bladder created from patients own intestine (Neobladder) can be done by robotic surgery.

For testicular cancer patient’s removal of lymph nodes from abdomen is sometimes needed. This can be done by robotic surgery safely and in a minimally invasive way. For penile cancer patients groin nodes surgery is sometimes required, this surgery usually has a lot of morbidity and issues with wound healing. VEIL is a kind of minimally invasive robotic technique of this surgery with marked lesser wound healing issues and a great advantage over open surgery.

Like Laparoscopic surgery Robotic surgery is useful for removing adrenal gland tumours. Reconstructive urological surgeries like repair of urinary leaks in Uretero-vaginal fistulas, Vesico-vaginal fistulas and Kidney Obstruction (Pyeloplasty) are done by robotic surgery with great ease and excellent outcome.

Robotic surgery is a game changer in the surgical approach to urological cancers. With increasing affordability, decreasing cost of the technology and more availability it is going to gain more popularity and used more commonly.

Medical science is evolving, technology is evolving and we should be open to learn and adapt to new technology to offer the best possible health care to the common people which is affordable for the majority of the population.