Roboterassistierte Operationen in der Urologie

Since 1990, laparoscopic surgery has undergone a tremendous evolution. As patients and surgeons alike push toward minimally invasive surgery, more and more complex operations have been performed by laparoscopy. However, highly complex and technically demanding procedures--such as radical prostatectomy--have revealed the limits of classical laparoscopic surgery. The introduction of the Da Vinci robot has changed the face of modern laparoscopy because it provides the surgeon with three-dimensional vision, more instrumental degrees of freedom, and greater ergonomics. Thus, laparoscopy has been able to strengthen its role in urology and is increasingly being used for radical prostatectomies, pyeloplasties, and ureteral operations such as ureterovesical reimplantations. For most types of operations, functional and early oncological outcomes appear similar to those of conventional laparoscopy or open surgery. The main drawbacks of robotic surgery are the costs of the disposable instruments and maintenance, which overshadow the initial purchase price. The near future will show how European health systems will react to this new financial burden. Our institution, within a university hospital with moderate patient recruitment, was equipped with a four-arm Da Vinci robot in February 2006. As of April 2008, 120 urological operations had been performed. Because robotic surgery is associated with a specific learning curve, divisions with limited case numbers may refrain from doing this type of surgery. The aim of this article is to evaluate the feasibility and efficiency of the initial period of a robotic program in a midsize division.