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Robotic-assisted Urologic Surgery Advances Clinical Care

In 2000, surgeons at Washington University were among the first in the United States to study the use of robots in operating rooms at Barnes-Jewish Hospital. Seven years later, surgeons at Barnes-Jewish Hospital began to regularly use the da Vinci® Surgical System in its operating rooms. Now, more than two decades later, Washington University urologic surgeons have embraced the assistance of surgical robots in routine and complex procedures.

Robot surgical systems do not autonomously perform surgeries. Instead, a skilled surgeon will utilize a console to carefully guide a set of robotic instruments. Viewed through an instrument fitted with a high-definition camera, the console translates the surgeon’s precise hand movements in real time to bend and rotate the instruments.

Robotic-assisted techniques play a significant role in urologic surgery repertoires and are used to treat a variety of conditions, including prostate, kidney and bladder cancers at Siteman Cancer Center, as well as to reconstruct endourologic structures affected by disease and trauma.

“Since our team first got our hands on this advanced technology, we have worked diligently to research and integrate it into our surgical practice,” says R. Sherburne Figenshau, MD, the Taylor Family and Ralph V. Clayman Chair in Minimally Invasive Urology.

Washington University urologic surgeons also pioneered leading-edge robotic surgery techniques for minimally invasive procedures. In 2008, Urologic Surgery Chief Sam Bhayani, MD, MS, developed a technique for robotic partial nephrectomy, or removal of part of the kidney. Since its development, the procedure has been adopted around the world.

Advancements in robotic surgery techniques, including the institution’s acquisition of a Single Port (SP) Surgical System in 2019, have significantly impacted clinical care. While the preceding technology allowed surgeons to operate through a smaller number of incisions, the SP surgical robot can fit through a single incision. Since the introduction of robotic techniques in its facilities, urologic surgeons have found several advantages of robotic procedures over open surgery techniques, including less time in the operating room, reduced blood loss, smaller incisions, shorter hospital stay, and quicker recovery time.

As soon as the new system arrived, Eric Kim, MD, associate professor of urologic surgery, quickly mastered and integrated the technology into his surgical repertoire. As of March 2021, Kim completed his 100th SP robotic surgery case and utilizes the SP robot for prostatectomy (prostate removal), cystectomy (removal of part or the entire bladder) and radical or partial nephrectomy procedures. 

Yifan Meng, MD, PGY-5, training on the surgical robot.

“Any patient who is a candidate for robotic surgery using the single port system can benefit from this new technology,” says Kim. “Sometimes, anatomical differences or other issues may make it challenging to operate using conventional robotics techniques, and we’ve found that it the newer system can be particularly useful in these cases.”

Since the technology arrived on the medical campus, experts in the Division of Urologic Surgery have integrated robotic surgery technology into the program’s education curriculum, including its Urologic Surgery Residency program as well as its Society of Urologic Oncology, Urologic Trauma and Reconstruction, and Endourology Fellowship programs. Trainees in the programs have the opportunity to perform simulated procedures using robotic systems in the Washington University Institute for Surgical Education (WISE) Center.

Grant Henning MD, PGY-4 Urology Resident, training on a single port robot.

Kim, who earned his medical degree from Washington University School of Medicine and trained in urologic surgery under the mentorship of Figenshau, underwent hands-on training in robotic techniques, including the procedure pioneered by Bhayani in 2008, during his surgical residency and fellowship programs.

“I was honored to train with the highly skilled urologic surgeons at Washington University and as a faculty member and practicing surgeon, I am able to work alongside my mentors and share that knowledge with others,” says Kim. “When it comes to innovations in urologic surgery, robotic techniques are just the tip of the iceberg and I am thrilled to watch the nature of our practice evolve.”

Washington University urologists have experience in open, laparoscopic and robotic surgery, and work with patients to determine the best surgical approach for each individual.

To make an appointment with a Washington University urologist, please call 314-862-8200 or fill out the online appointment form.