Robotic Surgery

The da Vinci Surgical System is a sophisticated robotic surgical platform designed to enable complex surgery using a minimally invasive approach. The da Vinci System consists of an ergonomic surgeon’s console, a patient-side cart with four interactive robotic arms, a high-performance 3D HD vision system and proprietary EndoWrist® instruments. Powered by state-of-the-art robotic technology, the da Vinci System is designed to scale, filter and seamlessly translate the surgeon’s hand movements into more precise movements of the EndoWrist instruments. The net result is an intuitive interface with breakthrough surgical capabilities.

Robotic Surgery Procedures:
Many robotic surgery procedures are available, and each has been shown to help patients achieve their desired treatment results. Meanwhile, the robotic surgery experts at Comprehensive Urology in Los Angeles are happy to teach patients about robotic surgery, how it works, and its benefits. Our team ensures patients can weigh the pros and cons of robotic surgery and address any concerns or questions prior to treatment. That way, patients can always make an informed decision about their treatment approach.

At Comprehensive Urology, we tailor the robotic surgery procedures to the individual needs and unique findings of each patient to ensure optimal results. Our robotic surgery procedures include:

• Robotic Prostate Surgery
• Robotic Kidney Surgery
• Robotic Bladder Surgery
• Robotic Adrenal Surgery
• Robotic Varicocele Surgery
• Robotic Vaginal Vault Suspension
• Robotic Urinary Fistula Repair

About The da Vinci Surgical System:

The two main features of the da Vinci Surgical System include:

• Intuitive® motion, high-resolution 3D vision
• Innovative EndoWrist instrumentation

Intuitive motion refers to the System’s interface, which helps make da Vinci surgery look and feel like traditional “open” surgery. But this is where the similarities end.

The da Vinci robot system’s high-resolution 3D stereo viewer is designed to provide surgeons with an immersive experience. Unlike conventional approaches, the target anatomy appears at high magnification, in brilliant color and with natural depth of field. To perform a procedure in Los Angeles, the surgeon uses the console’s master controls to maneuver the patient-side cart’s four robotic arms, which securely hold the patented EndoWrist instruments and high-resolution endoscopic camera. The EndoWrist instruments’ jointed-wrist design exceeds the natural range of motion of the human hand; motion scaling and tremor reduction further interpret and refine the surgeon’s hand movements. A final hallmark of the da Vinci System is its fail-safe design, incorporating multiple, redundant safety features designed to minimize opportunities for human error when compared with traditional approaches.

The da Vinci System is a remarkable improvement over conventional laparoscopy, in which the surgeon operates while standing, using hand-held, long-shafted instruments, which have no wrists. With conventional laparoscopy, the surgeon must look up and away from the instruments to a nearby 2D video monitor to see an image of the target anatomy. The surgeon must also rely on his/her patient-side assistant to position the camera correctly. In contrast, the da Vinci System’s ergonomic design allows the surgeon to operate from a comfortable, seated position at the console, with eyes and hands positioned in line with the instruments. To move the instruments or to reposition the camera, the surgeon simply moves his/her hands.

By providing surgeons with superior visualization, enhanced dexterity, greater precision and ergonomic comfort, the da Vinci Surgical System makes it possible for more surgeons to perform minimally invasive procedures involving complex dissection or reconstruction. This ultimately raises the standard of care for complex surgeries, translating into numerous potential patient benefits.

With the da Vinci Surgical System, a surgeon is 100% in control of the system at all times. The system has already been used to deliver minimally invasive treatments to more than 3 million patients and continues to change the surgery experience for patients worldwide.

For the patient in Los Angeles, a da Vinci procedure can offer all the potential benefits of a minimally invasive procedure, including less pain, less blood loss and less need for blood transfusions. Moreover, the da Vinci System can enable a shorter hospital stay, a quicker recovery and faster return to normal daily activities. Clinical studies also suggest that the da Vinci System may help surgeons provide better clinical outcomes than conventional technologies allow — for example, better cancer control and a lower incidence of impotence and impotence and incontinence with da Vinci Prostatectomy.

Robotic Prostate Surgery

Men who have been diagnosed with prostate cancer or benign prostatic hyperplasia (BPH) are often recommended to undergo prostate surgery to remove the cancerous or enlarged tissue, particularly when conservative treatments have been ineffective. While the prospect of surgery can be intimidating, the urological surgeons at Comprehensive Urology are highly skilled at performing minimally invasive robotic prostate cancer surgery in Los Angeles with the da Vinci® Surgical System, which is the most advanced surgical method of treating prostate conditions available.

If you or a loved one has been diagnosed with cancer of the prostate or BPH, the urologists at Comprehensive Urology can provide the thorough minimally invasive treatment necessary to prevent the problem from worsening and helping you return to your everyday life.

Compared to standard open operations, most patients are able to recover from robotic prostate surgery in less time. Depending on the extent of the operation, patients can expect to spend one or two days in the hospital before returning home, rather than a week or more with traditional operations. Patients can also expect to experience less pain and swelling, however, these symptoms can be managed with rest and pain medication.

The recovery process varies for each patient, however, the urologists at Comprehensive Urology are dedicated to ensuring that each and every patient has the best possible outcome following robotic prostatectomy surgery and smoothest recovery.

Robotic Kidney Surgery

Prior to robotic surgery, surgeons traditionally treated kidney cancer by removing the entire kidney, a procedure called nephrectomy. This involved making a large incision in the abdomen in order to access the kidney. Laparoscopy, another form of kidney removal, involved making several small incisions in the abdomen allowing the surgeon to operate through the openings. Although nephrectomy and laparoscopy have been effective in the past, the surgeon’s range of motion is limited when utilizing these two methods.  Through robotic surgery using the da Vinci Surgical System, experienced surgeons are able to complete complex procedures with minimal incisions.

The da Vinci Surgical System for Robotic Kidney Surgery

Fortunately, Comprehensive Urology in Los Angeles offers robotic surgery, the most advanced surgical approach for kidney cancer today.  Not only is this type of surgery minimally invasive, it allows the surgeon to have better dexterity and finer hand control movements as well. At Comprehensive Urology, robotic surgery is performed through the da Vinci Surgical System, a sophisticated, minimally invasive robotic platform designed to enhance the surgeon’s capabilities and visualization. With the da Vinci Surgical System, miniaturized wristed instruments and a high-definition 3D camera are inserted through five or six small incisions in the abdomen. The platform allows the surgeon to be seated comfortably while being able to view the site of surgery inside a person’s body. Furthermore, the surgeon is able to intricately navigate through the site of surgery more seamlessly as the latest robotic and computer technologies filter and translate the surgeon’s hand movements into controlled micro movements.

Benefits of Robotic Surgery for Kidney Cancer

Today, more urologists are choosing robotic surgery for kidney cancer patients because they have come to recognize that it is best to remove only the cancerous part of the tissue while preserving as much of the normal kidney tissue as possible. This is especially beneficial for kidney cancer patients who have been diagnosed with diabetes or high blood pressure. Removing only the diseased part of the kidney in order to leave the patient with as much healthy kidney tissue possible is called a partial nephrectomy. It is suitable for patients who have kidney tumors less than 10 centimeters (4 inches) in size.

The beauty behind the da Vinci Surgical System used at Comprehensive Urology is that it allows the surgeon to perform all the steps of a partial nephrectomy, or any procedure for that matter, with precise movement and dissection. The tumor is identified and removed in the most minimally invasive way, which decreases the levels of stress and injury to the patient’s kidney. Patients who undergo robotic surgery for kidney cancer typically have less pain, less blood loss, and  less scarring and fewer side effects than those who choose traditional procedures such as laparoscopy and radical nephrectomy.

Robotic Bladder Surgery

If your doctor recommends that you or a loved one undergo robotic bladder surgery, whether to treat a urinary incontinence issue or bladder cancer, the prospect is probably more than a little intimidating. Fortunately, the expert urologists at Comprehensive Urology have extensive training and experience performing robotic-assisted surgical procedures, particularly with the da Vinci robotic surgical system. Robotic bladder surgery allows our urological surgeons to safely perform complex procedures with minimal incisions and improved recovery times.

How is Robot-Assisted Bladder Surgery Performed?

Minimally invasive robotic bladder surgery essentially involves using very small surgical tools that are attached to a robotic arm and computer station. The patient is given general anesthesia in order to sleep comfortably through the procedure without pain. With the robotic system, the urological surgeon only needs to make a few small incisions rather than the longer incisions that are typically used in traditional open surgery, which can involve cutting through muscle to reach the bladder.

One of the instruments that the surgeon will use is an endoscope, which is a thin tube attached to a camera that allows the surgeon conduct the operation with clear, 3D images. Additionally, the robotic arms are able to perform the smallest, most precise movements, achieving accurate results with minimal incisions or damage to surrounding tissues and nerves.

Types of Robotic-Assisted Bladder Operations

The da Vinci robotic surgical system and other similar devices can be used to perform a wide range of complex procedures, including the following common operations for bladder conditions.

Partial or Radical Cystectomy

In many cases of aggressive bladder cancer, it is recommended that a portion or the entire bladder be removed to prevent the disease from spreading to other parts of the body. Robotic-assisted cystectomy ensures that only the targeted tissues and cells are removed, reducing the risk of complications and blood loss considerably. Robotic bladder surgery is often advised for patients older than 60 who might not be eligible for traditional open cystectomy.

Reconstructive Surgery

When the entire bladder is removed, the patient will need to undergo reconstructive surgery to create a surrogate bladder. In some cases, robot-assisted reconstructive surgery involves creating the following options:

1. A stoma or opening in the abdomen to attach a disposable bag,
2. A reservoir out of a section of the small intestine to store urine before it is emptied into an external pouch, or
3. A neobladder out of a section of the small intestine that can be emptied with a catheter inserted through the urethra.

Using a da Vinci robotic system to perform minimally invasive reconstructive bladder surgery is ideal for many patients as it reduces the number of incisions involved in an already life-changing operation. Fewer incisions can make the recovery process quicker and easier.

Robotic Bladder Diverticulectomy

Patients who have a bladder diverticulum, which is a small pouch or sac that develops in the bladder wall as a result of congenital factors, urinary blockage, or nerve damage, may require surgery. Treatment is not always necessary, however, minimally invasive surgery may be performed to remove any blockages and even the diverticulum if the patient is suffering from bladder stones, frequent urinary tract infections, bladder tumors, or urinary reflux.

Benefits of Robotic-Assisted Bladder Surgery

Minimally invasive robotic bladder surgery can provide a number of benefits over traditional open operations, including the following:

• Minimal incisions
• Lower risk of infections
• Reduced post-operative pain and scarring
• Less post-operative pain medicine
• Reduced risk of damaging erectile nerves
• Less blood loss
• Quicker recovery times
• Enhanced 3D visualization for the surgeon

As with any surgical procedure, there is a degree of risk with minimally invasive robotic bladder surgery. The team at Comprehensive Urology is dedicated to achieving the best possible outcome for each patient and strive to make our patients as comfortable and confident as possible before any procedure.

Prior to any minimally invasive treatment, we ensure that our patients are well informed about the advantages and disadvantages of treatment and what to expect in order to provide the best comprehensive care.

What to Expect During Recovery from Robotic Bladder Surgery

As a minimally-invasive procedure, most patients are able to heal and get back to their daily lives in less time than it would normally take with open surgery. Larger incisions pose greater risks of infection and greater post-operative pain, which can extend the recovery period by several days or even weeks, depending on the patient.

Patients may expect to use a catheter during the first several days depending on the type of operation and whether the bladder is still intact. Additionally, patients can expect to spend one to two days in the hospital following the surgery rather than a full week as with open surgery. Every patient is unique and the urologists at Comprehensive Urology adjust follow-up care and guidance accordingly. Our goal is to ensure the smoothest and most comfortable transition back to everyday life.

Robotic Adrenal Surgery

Robotic-assisted adrenalectomy involves the partial or full removal of the adrenal gland. Most people have two adrenal glands, and if one is removed, the remaining gland can perform the functions of both.

A traditional open adrenalectomy requires a large flank incision in the abdomen. Comparatively, during robotic-assisted adrenalectomy, a surgeon uses the da Vinci System to make four to five incisions in the abdomen to remove an adrenal tumor. If the tumor has cancer that has spread to the lymph nodes, the nodes may be removed as well. A surgeon places tissue to be removed into a small pouch. Then, the surgeon removes this bag via tiny incisions in the abdomen.

Robotic adrenal surgery generally results in less pain than a standard open procedure. Also, with robotic-assisted adrenalectomy, there is reduced blood loss, less scarring, and a shorter hospital stay and recovery period in comparison to a traditional adrenalectomy.

Meanwhile, robotic adrenal surgery enables a surgeon to use a robotic camera and instruments for unprecedented visualization and dexterity. The da Vinci System provides supreme precision and accuracy, and as such, helps the surgeon avoid contact with the spleen, liver, pancreas, and other organs near the adrenal glands.

Robotic Varicocele Surgery

Varicocele is a condition in which the veins just above the testicles become swollen and inflamed, not unlike varicose veins that occur in the legs. While varicoceles may not cause any symptoms, it can impact a man’s sperm count and quality, interfering with his ability to have children. If you suspect you may have varicocele, do not wait to get examined by a skilled urologist, such as the team at Comprehensive Urology. Varicocele can become progressively worse over time, leading to pain and infertility, if left untreated.

Our exceptional urologists in Los Angeles are highly trained and compassionate, focusing on reaching the best possible outcome for each and every patient’s unique needs and circumstances.

What are the Signs of Varicoceles?

In many cases, some men do not experience any symptoms from varicoceles, but may not swelling or inflammation of the veins at the top of the testicles. The left side is usually affected, if not both sides. However, as the vein becomes more inflamed and engorged with blood, it may cause aching pain or a feeling of heavy weight within the scrotum, which may become more intense when standing for a long period of time.

Treating with Robotic Varicocelectomy

Depending on the extent of the varicoceles and a patient’s health and lifestyle, the condition may not require immediate treatment, however, it is crucial to have the condition evaluated by a skilled urologist to determine the best course of action. In the event that the swelling and inflammation worsens, minimally invasive treatment may be necessary.

At Comprehensive Urology, our urologists have extensive experience evaluating and diagnosing varicoceles, as well treating the condition with the latest, most effective techniques and technology. Robotic varicocelectomy is one of the most advanced, minimally invasive options available for alleviating the discomfort and reduced sperm quality associated with varicoceles. This minimally invasive surgical procedure is ideal for many patients because of the following benefits:

• Only small, minimally invasive incisions are needed in the groin or abdomen
• The da Vinci Surgical System allows the surgeon to have a clear, 3-D view of the varicoceles without needing open surgery
• The robotic surgery gives the surgeon optimum control and precision
• Minimal incisions reduce pain and bleeding
• Patients experience a much smaller risk of scarring
• Recovery times are much shorter
• Less time spent in the hospital

For patients in Los Angeles who have experienced a drop in sperm production and quality, a minimally invasive robotic varicocelectomy can help reverse the damaging effects of the inflamed veins leading to the testicles. By undergoing a minimally invasive procedure, you can prevent the condition from worsening and limiting your life choices in the future.

Robotic Vaginal Vault Suspension

Robotic vaginal vault suspension uses the da Vinci System to perform a vaginal procedure via small incisions. The procedure addresses uterine and vaginal vault prolapse that occurs when connective tissues or muscles within the body cavity become wear and can no longer held the pelvic organs in their natural position. Connective tissues and muscles weaken with age, after child birth, or due to weight gain or strenuous physical activity. When these tissues and muscles deteriorate, urinary incontinence, pelvic pain or pressure, vaginal ulceration, sexual dysfunction, and other problems may occur. Now, robotic vaginal vault suspension helps women address uterine and vaginal vault prolapse and offers many advantages over a traditional open vaginal vault suspension procedure.

The benefits of robotic vaginal vault suspension include:

• Less Pain: Robotic vaginal vault suspension patients typically experience less pain in comparison to patients who undergo a standard open vaginal vault suspension procedure.
• Shorter Hospital Stay: Robotic vaginal vault suspension is a minimally invasive procedure and requires minimal downtime following surgery.
• Quick Return to Everyday Activities: Most robotic vaginal vault suspension patients won’t have to wait long to resume their everyday activities.

Comprehensive Urology’s team of expert urologists is happy to teach patients about robotic vaginal vault suspension. Our team also helps patients determine if robotic vaginal vault suspension is a viable treatment option.

Robotic Urinary Fistula Repair

A fistula refers to a hole that develops between two adjacent parts of the body. Sometimes, a fistula may form in the female urinary system. When this happens, urine may leak into the vagina, uterus, or other parts of the body. It may also make a woman susceptible to urinary incontinence, chronic urinary tract infections, and other long-term health conditions.

Robotic urinary fistula repair enables a surgeon to perform fistula repair via tiny incisions in the abdomen. A surgeon can use the da Vinci Surgical System’s robotic instruments to close and treat a fistula with unparalleled precision and accuracy. Plus, robotic urinary fistula repair has been shown to provide faster recovery and a shorter hospital stay in comparison to using traditional abdominal surgery for fistula repair.

Robotic Surgery FAQs

Q: What is minimally invasive surgery?

A: Traditional surgery requires the use of large openings. Comparatively, minimally invasive surgery involves the use of small incisions. Minimally invasive surgery generally provides a faster recovery time, less blood loss, and smaller scars in comparison to traditional open surgery. As such, patients often prefer minimally invasive surgery over traditional open surgery.

Q: What are the risks associated with robotic surgery?

A: Like any surgery, there are risks associated with robotic surgery. These include heart attack, stroke, and death. A urologist performs a comprehensive pre-operative assessment of a patient’s overall health prior to treatment to identify potential risks and determine if a patient is a viable candidate for robotic surgery.

Q: Does the da Vinci Surgical System deliver proven results?

A: The da Vinci Surgical System is quickly becoming a popular option for minimally invasive surgeries because it provides fast, safe, and effective results for patients. It has been approved by the U.S. Food and Drug Administration (FDA) for use in a variety of procedures. Furthermore, more than 7,000 peer-reviewed articles have been published that highlight the benefits of the da Vinci Surgical System. The amount of clinical evidence to support the use of the da Vinci Surgical System for minimally invasive surgeries is increasing at a rate of 100 publications per month, too.

Q: What does a surgeon “feel” during robotic surgery?

A: The da Vinci Surgical System features motors that enable a surgeon to move the robotic arms and instruments based on his or her hand movements on the controls. These movements allow a surgeon to receive subtle physical “feedback” while holding the controls. This feedback substitutes for a surgeon’s sense of touch, and it is augmented by a high-definition 3D view of a patient. Thus, even though a surgeon cannot physically touch or feel a patient’s anatomy during robotic surgery, the da Vinci Surgical System offers advanced visualization, precision, dexterity, and control to compensate for the loss of touch.

Q: Is everyone eligible for robotic surgery?

A: Robotic surgery is used to treat a variety of conditions, but it is not ideal for each patient. In some instances, patients cannot tolerate the inflating of the abdominal area with carbon dioxide during robotic surgery. This is a common problem for smokers, as these individuals may have higher levels of carbon dioxide in the blood than non-smokers. Body positioning may also be an issue for some patients. During robotic surgery, a patient may be tilted on the operating table; this allows the surgeon to shift the organs away from the surgical site and provides him or her with better access to the surgical site. For some patients, this position may make it difficult to provide oxygen at a safe pressure to the lungs.

Q: During robotic surgery, does the robot perform the procedure?

A: The robot is always under the control of a surgeon – without exception. Plus, the robot cannot be programmed or make any movements on its own.

Q: When can I return home after robotic surgery?

A: In many instances, robotic surgery patients can return home the same day as surgery or the day after surgery. Additionally, patients may be able to return to work within one to two weeks of robotic surgery.

Q:How long does it take to recover after robotic surgery?

A: The recovery time following robotic surgery varies based on the patient and his or her treatment. A urologist may provide an estimated recovery timeline prior to robotic surgery.

Although a patient may recover from robotic surgery faster than he or she would from a traditional open surgery, it is important for this individual to allocate time for proper healing. By doing so, a patient can ensure a robotic surgery delivers the optimal results.

Is Robotic Surgery Right for You?

Although robotic surgery is considered a safe and effective minimally invasive treatment option for kidney, adrenal, and prostate tumors, as well as many other benign conditions. It is important to remember that no two conditions are alike. It is best to contact us and fully discuss your options with an experienced urologist so that both of you can determine if minimally invasive robotic surgery is best for you. The Comprehensive Urology team in Los Angeles is one of the most specialized and experienced groups of urologists in minimally invasive robotic surgery. If you would like to discuss your treatment options with the leaders in the field of urology and kidney cancer, call (310) 499-2756 today.