Pioneering Robotic Surgery

Minimally invasive surgery is the key treatment today for urologic cancer, and Ashok Hemal, MD, is among the most experienced surgeons in the world in laparoscopic and robotic prostate surgery. The latter he was a pioneer in establishing in the field of urology.

Hemal, director of Wake Forest Baptist Medical Center’s Robotic and Minimally Invasive Urologic Surgery Program, completed groundbreaking research to compare the two modern techniques.

Hemal’s Research

Hemal treated 30 patients over 18 months with each of the two techniques and published the results in the Canadian Journal of Urology.

He found that the two surgeries to repair kidney blockages that prevent urine from draining normally to the bladder were equally effective. But robot-assisted surgery was faster and resulted in less blood loss and shorter hospital stays than laparoscopic surgery.

All 60 patients had a procedure known as pyeloplasty, which involves reconstructing the narrow area where the kidney meets the ureter, the tube that carries urine from the renal pelvis into the bladder. Blockages in this area can be the result of birth defects or, in adults, from injury, previous surgery or disorders that can cause inflammation of the upper urinary tract.

In laparoscopic surgery, the surgeon directly manipulates a viewing device and operating instruments inserted into the abdomen; in robot-assisted surgery, the surgeon sits at a console and uses hand and finger movements to control centimeter-size instruments while viewing the surgical site on a screen.

“The evolution of laparoscopic surgery in urology has been limited because it is technically challenging and requires the surgeon to be proficient in advanced suturing,” Hemal said. “Robot-assisted surgery offers a way of overcoming some of the major impediments of laparoscopic surgery. This study shows the two options are equally effective and that robot-assisted surgery has several advantages.”