Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

Technology Insight: surgical robots—expensive toys or the future of urologic surgery?

Nature Clinical Practice Urology volume 1, pages 97–102 (2004)Cite this article

Abstract

There is an increasing demand for minimally invasive surgery, despite any controversy over whether patients benefit from minimally invasive procedures rather than undergoing open surgery. In the field of urology, the performance of more complicated procedures is still a challenge even for experienced laparoscopic surgeons. Recently, robots have been introduced to enhance operative performance, increase applicability and precision of laparoscopy, and improve the learning curve for complicated minimally invasive procedures. With the introduction of master–slave systems where the surgeon is seated remotely from the robot and uses controls to maneuver the mechanical arms placed inside the patient, a new development in robot-assisted surgery has commenced. Several authors have suggested that surgical robots similar to the da Vinci Surgical System® (Intuitive Surgical, Sunnyvale, CA), which have three-dimensional (3D) vision and wristed instruments thus giving a greater degree of freedom than rigid laparoscopic instruments, will facilitate the outcome of these more challenging laparoscopic procedures. Whether these features will translate into better functional and oncological results remains to be evaluated. Data published so far clearly suggest that the patient will benefit from less postoperative pain, decreased bleeding and a shorter hospital stay compared with open surgery, and that the surgeon benefits from a faster learning curve than for conventional laparoscopy. For the benefit of our patients and for the development of urology it is vital that we understand both the limitations of telerobotics and when it is appropriate to incorporate these new techniques in day-to-day urologic surgery.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Operating room setup for robot-assisted surgery.
Figure 2: Operation times for three surgeons performing robot-assisted prostatectomy at the Karolinska Hospital, Stockholm, Sweden.

Similar content being viewed by others

References

  1. Clayman RV et al. (1991) Laparoscopic nephrectomy: initial case report. J Urol 146: 278–282

    Article  CAS  Google Scholar 

  2. Gettman MT et al. (2003) Current status of robotics in urologic laparoscopy. Eur Urol 43: 106–112

    Article  Google Scholar 

  3. Schuessler WW et al. (1997) Laparoscopic radical prostatectomy: initial short-term experience. Urology 50: 854–857

    Article  CAS  Google Scholar 

  4. Guillonneau B et al. (1999) Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations. Eur Urol 36: 14–20

    Article  CAS  Google Scholar 

  5. Abbou CC et al. (2000) Laparoscopic radical prostatectomy: preliminary results. Urology 55: 630–634

    Article  CAS  Google Scholar 

  6. Moinzadeh A and Gill IS (2004) Laparoscopic radical cystectomy with urinary diversion. Curr Opin Urol 14: 83–87

    Article  Google Scholar 

  7. Bann S et al. (2003) Robotics in surgery. J Am Coll Surg 196: 784–795

    Article  Google Scholar 

  8. Kwoh YS et al. (1988) A robot with improved absolute positioning accuracy for CT guided stereotactic brain surgery. IEEE Trans Biomed Eng 35: 153–160

    Article  CAS  Google Scholar 

  9. Borner M et al. (1999) Computer-assisted surgery for hip endoprosthesis. Z Arztl Fortbild Qualitatssich 93: 253–258

    CAS  PubMed  Google Scholar 

  10. Kavoussi LR et al. (1994) Telerobotic assisted laparoscopic surgery: initial laboratory and clinical experience. Urology 44: 15–19

    Article  CAS  Google Scholar 

  11. Kavoussi LR et al. (1995) Comparison of robotic versus human laparoscopic camera control. J Urol 154: 2134–2136

    Article  CAS  Google Scholar 

  12. Guillonneau B (2003) What robotics in urology? A current point of view. Eur Urol 43: 103–105

    Article  Google Scholar 

  13. Sung GT and Gill IS (2001) Robotic laparoscopic surgery: a comparison of the da Vinci and Zeus systems. Urology 58: 893–898

    Article  CAS  Google Scholar 

  14. Menon M et al. (2002) Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes. J Urol 168: 945–949

    Article  Google Scholar 

  15. Gill IS et al. (2000) Robotic remote laparoscopic nephrectomy and adrenalectomy: initial experience. J Urol 164: 2082–2085

    Article  CAS  Google Scholar 

  16. Hubert J (2003) Robotic pyeloplasty. Curr Urol Rep 4: 124–129

    Article  Google Scholar 

  17. Ahlering TE et al. (2003) Successful transfer of open surgical skills to laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatectomy. J Urol 170: 1738–1741

    Article  Google Scholar 

  18. Tewari A et al. (2002) Technique of da Vinci robot-assisted anatomic radical prostatectomy. Urology 60: 569–572

    Article  Google Scholar 

  19. Menon M et al. (2003) Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int 92: 232–236

    Article  CAS  Google Scholar 

  20. Beecken WD et al. (2003) Robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an ortotopic ileal neobladder. Eur Urol 44: 337–339

    Article  Google Scholar 

  21. Menon M et al. (2004) Robot-assisted radical cystectomy and urinary diversion in female patients: technique with preservation of the uterus and vagina. J Am Coll Surg 198: 386–393

    Article  Google Scholar 

  22. Menon M (2003) Robotic radical retropubic prostatectomy. BJU Int 91: 175–176

    Article  CAS  Google Scholar 

  23. Rassweiler J et al. (2003) Laparoscopic versus open radical prostatectomy: a comparative study at a single institution. J Urol 166: 1689–1693

    Article  Google Scholar 

  24. Hoznek A et al. (2001) Laparoscopic radical prostatectomy: the Créteil experience. Eur Urol 40: 38–45

    Article  CAS  Google Scholar 

  25. El-Feel A et al. (2003) Laparoscopic radical prostatectomy-an analysis of factors affecting operating time. Urology 62: 314–318

    Article  Google Scholar 

  26. Sarle R et al. (2004) Surgical robotic and laparoscopic training drills. J Endourol 18: 66–67

    Article  Google Scholar 

  27. Bentas W et al. (2003) Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol 44: 175–181

    Article  Google Scholar 

  28. Guillonneau B et al. (2002) Perioperative complications of laparoscopic radical prostatectomy: the Montsouris 3-year experience. J Urol 167: 51–56

    Article  Google Scholar 

  29. Tü rk I et al. (2001) Laparoscopic radical prostatectomy: technical aspects and experience with 125 cases. Eur Urol 40: 46–53

    Article  Google Scholar 

  30. Dahl DM et al. (2002) Laparoscopic radical prostatectomy: initial 70 cases at a U.S. university medical center. Urology 60: 859–863

    Article  Google Scholar 

  31. Tewari A et al. (2003) A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 92: 205–210

    Article  CAS  Google Scholar 

  32. Ahlering TE et al. (2004) Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Urology 63: 819–822

    Article  Google Scholar 

  33. Noldus J et al. (2003) Treatment of prostate cancer: the clinical use of radical prostatectomy. EAU Update Series 1: 16–22

    Article  Google Scholar 

  34. Gregori A et al. (2003) Laparoscopic radial prostatectomy: perioperative complications in an initial and consecutive series of 80 cases. Eur Urol 44: 190–194

    Article  Google Scholar 

  35. Hemal AK et al. (2003) Laparoscopic radical cystectomy and ileal conduit reconstruction: preliminary experience. J Endourol 17: 911–916

    Article  CAS  Google Scholar 

  36. Guazzoni G et al. (2003) Laparoscopic nerve- and seminal-sparing cystectomy with orthotopic ileal neobladder: the first three cases. Eur Urol 44: 567–572

    Article  Google Scholar 

  37. Simonato A et al. (2003) Laparoscopic radical cystoprostatectomy: a technique illustrated step by step. Eur Urol 44: 132–138

    Article  Google Scholar 

  38. McGinnis DE et al. (2004) Hand-assisted laparoscopic cystoprostatectomy and urinary diversion. J Endourol 18: 383–386

    Article  Google Scholar 

  39. Balaji KC et al. (2004) Feasibility of robot-assisted totally intracorporeal laparoscopic ileal conduit urinary diversion: initial results of a single institutional pilot study. Urology 63: 51–55

    Article  CAS  Google Scholar 

  40. Hemal AK et al. (2004) Complications of laparoscopic cystectomy during the initial experience. Int J Urol 11: 483–488

    Article  Google Scholar 

  41. Sanderson KM et al. (2004) The evolving role of pelvic lymphadenectomy in the treatment of bladder cancer. Urol Oncol 22: 205–211

    Article  Google Scholar 

  42. Ghoneim MA and Abol-Eneim H (2004) Lymphadenectomy with cystectomy: is it necessary and to what is its extent. Eur Urol 46: 457–461

    Article  Google Scholar 

  43. Artibani W et al. (2003) Is laparoscopic radical prostatectomy better than traditional retropubic radical prostatectomy? An analysis of peri-operative morbidity in two contemporary series in Italy. Eur Urol 44: 401–40655

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Head of Urology at Karolinska University Hospital,

    N Peter Wiklund

  2. Vice Chairman of the Department of Surgical Science at the Karolinska Institute, Stockholm, Sweden

    N Peter Wiklund

Authors
  1. N Peter Wiklund
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to N Peter Wiklund.

Ethics declarations

Competing interests

The author declares no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wiklund, N. Technology Insight: surgical robots—expensive toys or the future of urologic surgery?. Nat Rev Urol 1, 97–102 (2004). https://doi.org/10.1038/ncpuro0055

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpuro0055

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing