Robotic Urological Surgery: State of the Art and Future Perspectives

Minimally invasive surgery has gained popularity over the last decade by offering shorter convalescences, improved peri-opertive outcomes as well as enhanced cosmesis. Community urologists have typically performed standard laparoscopic nephrectomies secondary to its short learning curve, low complication rate, and limited requirement for sophisticated laparoscopic skills. However, advanced minimally invasive operations such as partial nephrectomies, pyeloplasties and prostatectomies necessitate advanced laparoscopic adeptness. The emergence of robotics, with 3D vision and articulated instruments, has allowed wider applications of minimally invasive techniques for more complex urological procedures. Though robotics has overcome some shortcomings of laparoscopic surgery, there remains a limitation with its assertion as a standard amongst the urological community. The lack of tactile feedback, displacement of the surgeon from the bedside, fixed-port system, longer operating room times and cost remain barriers to widespread acceptance of robotics. In addition, the deficiencies within the robotic platform have propagated an evolution in the field with micro and nano-robotics. This chapter highlights the history of robotic surgery along with current and future applications.