Urologic Robotic Surgery in Clinical Practice Prokar Dasgupta Editor Urologic Robotic Surgery in Clinical Practice Foreword by James O. Peabody and Mani Menon 123 Editor ProkarDasgupta DepartmentofUrology Guy’sHospital London UK [email protected] ISBN:978-1-84800-242-5 e-ISBN:978-1-84800-243-2 DOI:10.1007/978-1-84800-243-2 BritishLibraryCataloguinginPublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressControlNumber:2008936130 (cid:2)c Springer-VerlagLondonLimited2008 Apartfromanyfairdealingforthepurposesofresearchorprivatestudy,or criticismorreview,aspermittedundertheCopyright,DesignsandPatents Act1988,thispublicationmayonlybereproduced, storedortransmitted, in any form or by any means, with the prior permission in writing of the publishers,orinthecaseofreprographicreproductioninaccordancewith thetermsoflicensesissuedbytheCopyrightLicensingAgency.Enquiries concerningreproductionoutsidethosetermsshouldbesenttothepublishers. Theuseofregisterednames,trademarks,etc.,inthispublicationdoesnot imply, even in the absence of a specific statement, that such names are exemptfromtherelevantlawsandregulationsandthereforefreeforgeneral use. Thepublishermakesnorepresentation,expressorimplied,withregardto the accuracy of the information contained in this book and cannot accept anylegalresponsibilityorliabilityforanyerrorsoromissionsthatmaybe made. Product liability: The publisher can give no guarantee for information aboutdrugdosageandapplicationthereofcontainedinthisbook.Inevery individual case the respective user must check its accuracy by consulting otherpharmaceuticalliterature. Printedonacid-freepaper SpringerScience+BusinessMedia springer.com Tofamily,friends,andthe scienceofrobotics Foreword Computer-enhanced (robotic) surgery is an accepted part of thetreatmentofvarioussurgicaldiseases.Sinceitsinception at the turn of this century—8 years ago—robotic-assisted laparoscopic prostatectomy has become the predominant form of surgical treatment for clinically localized prostate cancer in the United States. While robotic-assisted prosta- tectomy is the first procedure to be performed in great numbers, it is projected that other procedures such as laparoscopic hysterectomy will begin to be performed more commonly with robotic assistance. In fact, most surgical disciplinesarebeginningtoadoptroboticassistanceforsome of their procedures. Advanced removal and reconstructive proceduresareregularlyperformedingeneralsurgery,head and neck surgery, gynecologic surgery, pediatric surgery, and cardiovascular surgery. The robotic platform that is commonly used (da VinciTM from Intuitive Surgical) has evolved over the past decade with development of the 4th arm,thetileprofeature,smallerinstrumentationandnewer instrumentationforspecificprocedures.Itisanticipatedthat further developments will make this platform and future platformseveneasierandmoreeffectivetouse.Costremains an extremely important issue for practitioners, hospitals, health plans, and governments as they consider adoption of computer-assisted surgery. This continues to be a barrier to wider adoption of the technology. It is hoped that costs for this equipment will decline as the technology develops and new manufacturers begin to produce robotic platforms, but sofarthishasnothappened. ProfessorDasguptawasamongthefirstintheUKtoem- bracetheuseofcomputer-enhanced(robotic)surgeryandhis vii viii Foreword textbook is a timely addition to the field of robotic-assisted urologic surgery. This field has rapidly passed through a period of procedure development and the techniques (with variations) that are presented within the book are now well developed.Thechapterscoverthemost-commonprocedures in urology that are being performed with contributions by a variety of international experts. In addition, it addresses the importantissuesofeconomicsandthebasicscienceandtech- nologyofrobotics. Surgery is evolving toward less invasive approaches to most procedures and what we have learned through the development of laparoscopic approaches and now computer enhancement should allow for even more minimal access. Multiple instruments will be placed through a single access site and natural orifices will be used as ports of entry. Sim- ulation will allow surgeons to practice the operation before doing it on the patient. Each of these should allow us to do less harm to our patients while we are trying to help them. Theseareexcitingtimestobeasurgeon. JamesO.PeabodyMDFACS andManiMenonMDFACS VattikutiUrologyInstitute HenryFordHealthSystem Detroit,MIUSA Contents 1 RoboticTechnology............................. 1 OussamaElhageandNicholasHegarty 2 TheBasicScienceofRoboticSurgery............. 21 BenChallacombeandDanStoianovici 3 RoboticProstatectomy .......................... 45 VipulR.Patel,KennethJ.Palmer, GeoffCoughlin,andMarioF.Chammas 4 ComparisonofRoboticLaparoscopicandOpen RadicalProstatectomy .......................... 67 Evangelos Liatsikos, Panagiotis Kallidonis, Jens-Uwe Stolzenburg, Roger Kirby, andChristopherAnderson 5 Robotic-AssistedRadicalCystectomy ............ 113 P.Dasgupta,P.Rimington,A.K.Hemal, andM.S.Khan 6 Robotic-AssistedLaparoscopicPyeloplasty ....... 133 DeclanG.Murphy,JamieKearsley, andAnthonyJ.Costello 7 RoboticPediatricUrology....................... 149 IqbalS.Shergill,ManitArya,andImranMushtaq ix x Contents 8 RoboticGynecology/Urogynecology.............. 159 Kankipati Shanti Raju, Andreas John Papadopoulos,andMohammadShamimKhan 9 Anesthesia andRobotic-AssistedSurgery.................... 181 LisaBlake,MarcinSicinski,andSanjayGulati 10 HealthEconomicsofRoboticSurgery ............ 195 QingWang,DavidArmstrong, andAlistairMcGuire Index .............................................. 233 Contributors ChristopherAnderson DepartmentofUrology,StGeorgesHospital,London,UK e-mail:[email protected] DavidArmstrong Department of General Practice, Kings College London SchoolofMedicine,London,UK e-mail:[email protected] ManitArya UniversityCollegeHospital,London,UK e-mail:manit [email protected] LisaBlake Department of Anesthetics, Guy’s & St Thomas’ NHS FoundationTrust,London,UK e-mail:[email protected] BenChallacombe DepartmentofUrology,Guy’sHospital,London,UK e-mail:[email protected] MarioF.ChammasJr DepartmentofUrology,NancySchoolofMedicine,Nancy, France AnthonyJ.Costello Department of Urology, Royal Melbourne Hospital, Victoria,Australia e-mail:[email protected] xi