Robotic and advanced laparoscopic urology

Robotic surgery is a type of laparoscopic (“keyhole”) surgery and has advantages over traditional laparoscopic surgery by virtue of the “wristed” instruments, which allow significantly greater dexterity, as well as the high definition, 3D camera system. As for any other surgical approach, outcomes following robotic surgery depend on the training and skill of the surgeon and are not intrinsic to the robotic platform.

Robotic surgery for prostate cancer offers advantages over open surgery, including lower blood loss and blood transfusion rates, less post-operative pain, shorter hospital stay and earlier return to normal activity. In addition to performing the standard “anterior” approach to robotic prostatectomy, Phil is one of the only surgeons in Australia to perform the “Retzius sparing” technique. This procedure has been shown to preserve early urinary continence in most patients, but is performed in only a small number of centres around the world because of the complexity of the approach. Following surgery with this technique, just over half of patients are free of continence pads within 1 week of catheter removal. Phil will discuss this approach with patients who meet certain clinical requirements prior to surgery.

Phil performs robotic cystectomy (removal of the bladder) for all patients with advanced bladder cancer. The advantages of this technique over open surgery include lower blood loss and blood transfusion rates, less pain post-operatively and shorter hospital stay. Phil performed the first cystectomy with robotic reconstruction in Melbourne and offers this approach to all patients requiring removal of the bladder, including those suitable for neobladder reconstruction (creation of a new bladder from small intestine).Phil has one of the highest case volumes of this approach in Australia and published the first Australian series of robotic cystectomy in 2018.

Robotic and laparoscopic surgery for kidney cancer includes partial nephrectomy (where the tumour is removed and the kidney is preserved) and radical nephrectomy (in which the entire kidney is removed). Phil has extensive experience in both of these procedures and will only perform radical nephrectomy for the most complex tumours, where preservation of the kidney is not feasible. The robotic approach in partial nephrectomy has the advantages of decreasing blood loss, post-operative pain and complication rates in comparison to open surgery in addition to allowing earlier return to normal activity. The dexterity of the robotic instruments allows much more precise placement of sutures when reconstructing the kidney in comparison to the laparoscopic approach. Phil has presented at national and international conferences on robotic partial nephrectomy techniques.

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