#259- Robotic Surgery in PFUI: Stretching the limits of Robotic technology- Dr. Shrey Jain

This is one of the 2023 KS International Innovation Awards videos selected for inclusion in the Vattikuti Foundation – ORSI Humans on the Cutting Edge of Robotic Surgery Conference, October 6, 7 & 8, 2023 in Ghent, Belgium. Posting does not imply that is has been selected as a Finalist, just that the content will be discussed at the Conference.

From the entry: Description: Herein we describe the use of surface robotics in proper approximation of the urethral ends in cases of pelvic floor urethral injuries.

Abstract: Title Stretching the limits of Robotic technology

Introduction: Urethral anastomosis in PFUI is the cornerstone of surgical restoration of the urethral continuity with mucosa to mucosa anastomosis. Herein we describe the use of surface robotics in proper approximation of the urethral ends without doing pubectomy.

Methods: Three patients from October 2022 to June 2023 with PFUI had robot assisted end to end urethroplasty at our centre. Median age was 25 (22-33) years. Bladder neck was competent in all three patients. Patients were placed in low lithotomy position to allow entry of Da Vinci robotic platform (Xi). Standard perineal dissection was performed to dissect proximal urethra. 3 free floating robotic arms were used (1 camera, 2 working arms). Assistant was sitting on the foot end watching the surgery on the screen and assisting at every step of surgery. 3-0 V-Lock continuous suture was used to approximate the mucosal ends with precision. Foley catheter was kept for 2 weeks. No suprapubic catheter was placed.

Results: Median operating time was 120 (100-140) minutes. Postoperative period was uneventful. Blood loss was less than 100 ml. All 3 patients voided well after the removal of catheter at 2 weeks. At a median follow up of 4 months (3-8 months), none of the patients had recurrence.

Conclusion: Mucosa to mucosa end to end urethroplasty could be achieved with the help of robot assistance without doing corporal separation and or inferior pubectomy. Robotic approach looks promising due to its inherent design to reach deeper and narrower spaces.

See more at: https://vattikutifoundation.com/videos/