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Robot-assisted Surgery in Urology

Prof. Dr. Christian Gratzke, Medical Director of the Department of Urology speaks about the function and possible uses of the Da Vinci robot at the Medical Center - University of Freiburg.

Robotically assisted surgery has established itself in many fields of surgery in the last ten to 15 years. We use robot-assisted surgery in many areas at the Medical Center - University of Freiburg. Not only in urology, but most of all in visceral surgery, in thoracic surgery, and also in gynecology. We are using a so-called Da Vinci robot here. This device had a monopoly position for many years, but more devices are sure to come into the market over the next few years.

Personally, I have already done over a thousand of these operations, and of course it takes a long time to be able to use these devices, too. It is important to remember that a robot cannot do anything on its own. It is operated by you or by the surgeon in the same way as the scalpel is used in open surgery. This means that the robot alone does not perform a good surgery, and depending on the operation you need, you will require a study group of 200 to 300 operations to be able to deliver correspondingly good results.

Why do we even use robots to operate?

We use robots because we want to have a better view of the anatomy. We are talking about a ten to 12 fold enlargement of the organs, which is a great improvement for the surgeon. We are talking about a 3D view the console allows us to have. All in all, it is a very pleasant way for a surgeon to operate, it is tremorless. Many studies, at least in urology, have shown that blood loss is also significantly lower than with so-called open surgery. We have been using these systems for many years.

Where are we heading now? Where should the future be?

We don't have any haptic feeling with the devices we are currently using. That means we don't feel when the devices meet resistance. This haptic feeling  should be added in the next few years. What we also expect is that big data will find its way into computer systems. Meaning that you can import several thousand data records from patients and operations, which has the advantage that it gives you a very precise knowledge of where or how you can operate the best. This means that the computer could be able to show you where blood vessels are, for example, or structures that you do not want to irritate.

These devices will hit the market in the near future. It is certainly a development that will continue for the next five to ten years until such devices are ready for the market.

Yes, the topic of prostate cancer is a very common topic because the prevalence of prostate cancer is very high. We are talking about the most common tumor in men, but not the tumor from which most patients actually die. And that's because we act very efficiently by early detection, screening. How do we do that?

By ascertaining the PSA value, by digital-rectal palpation of the prostate, but also increasingly by improving imaging. A very precise diagnosis is possible especially by MRI, but also by PSMA-PET / CT.

If a patient has prostate cancer that can be confined to an area, there are two therapy alternatives for him. On the one hand, there is radical prostatectomy, i.e. surgery, surgical removal of the prostate, on the other hand there is radiation therapy.

With this new generation of robots it is now possible to operate the prostate very precisely and also very gently. Personally, I am very honest with the patients and tell them that side effects and complications such as incontinence and impotence that can always occur, and cannot be avoided on principle even in robotic surgery.

The surgeon's experience is of importance. This applies to open surgery as well as to robot surgery. However, if you have a surgeon who can handle the robot very well, then you have the opportunity to see the structures, especially the nerves, very well and thus also protect them. Because of this, the incontinence and impotence rates are low. Another advantage of the robot is that patients are back on their feet faster, can go about their normal lives again sooner, and simply recover more quickly.

Who is robot-assisted surgery suitable for?

Basically for all patients. There are few exceptions. If a patient, in our case, has been operated several times on the abdomen, the adhesions that develop here can make access somewhat more difficult. It is still possible, it is just very complex. The same goes for patients who may have malformations in the brain, on the vessels. That means that if a patient has had a stroke or has an aneurysm in the brain for example, he cannot go into the head-down tilt position that we need to operate, and it is better not to do this type of surgery.

Prof. Dr. Christian Gratzke, Medical Director of the Department of Urology

Department of Urology