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“I found out that I needed an operation for a back problem which was causing severe pain to my left leg from the sciatic nerve. After speaking to my GP and realizing I was getting nowhere I decided to take the matter into my own hands as I could hardly walk. After speaking to private consultants and realizing that without private medical insurance I was not going to be seen to in this country without shelling out around £20,000 I decided to look elsewhere. I decided to look into having the operation privately in India and was fortunate to come across Mediescapes India. From my initial enquiry when I e-mailed my MRI results to Mediescapes India I was amazed ..more.”
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da Vinci Si Robotic Surgical system in India
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The da Vinci Si Robotic Surgical System is an FDA-approved system for laparoscopic prostatectomy surgery. With the da Vinci robotic system, the surgeon controls every aspect of the surgery via use of a robot. Currently, the only available integrated robotic surgical system is the da Vinci Surgical System.

Robotic surgery is the latest advancement in the field of minimally invasive or laparoscopic surgery. By integrating computer-enhanced technology with the surgeon’s skill, Robotic surgery enables the surgeons to perform precise, minimally invasive surgery in a manner that enhances healing and promotes well being.

Benefits of Robotic Surgery may include:

• Quicker return to normal activity
• Shorter hospitalization
• Less blood loss and lower blood transfusion rates
• Reduced pain
• Fewer complications
• Less risk of infection
• Less scarring than traditional open surgery

Robotic surgery in Urology

Following procedures are routinely done with robotic assistance.

• Robotic Radical prostatectomy for prostate cancer
• Robotic Radical Cystectomy for Urinary bladder cancer
• Robotic Radical Nepherectomy for Kidney cancer
• Robotic Partial Nepherectomy for Kidney cancer
• Robotic Pyeloplasty for PUJ obstruction in Kidney
• Robotic Pyelolithotomy for Large Kidney Stone Others (Surgery on Ureters,
  Adrenals and retroperitoneum)

Minimally Invasive Urologic Surgery

• Robotic radical Prostatectomy
• Robot assisted Radical Cystectomy
• Robotic Radical Nepherectomy
• Robotic Adrenal Surgery
• LASER Prostatectomy
• Robotic Pyeloplasty

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Robotic radical Prostatectomy is the most preferred way of treating localized prostate cancer.

Robotic prostatectomy is performed with the help of a Surgical Robot (da Vinci) through 4 to 5 small 1-cm keyhole incisions across the abdomen. Through these small incisions, the robotic arms enter the abdomen. The operating surgeon sitting at the operating console controls the robotic instruments to precisely dissect the prostate gland, seminal vesicles, and vasa deferentia from the urethra and bladder.

Once the prostate gland is dissected free from the bladder, rectum, and urethra, it is placed in a small plastic bag and eventually removed intact by extending one of the keyhole incisions. The complete prostate along with the lymph nodes are then sent to the histopathologist for detailed examination. The bladder is sewn back to the urethra to restore continuity of the urinary tract using robotic instruments and absorbable suturing material. A Foley catheter is placed through the penis to drain the bladder and allow healing of the bladder-urethra connection. In addition, a small drain is placed around the surgical site, exiting one of the keyhole incisions.

Robotic surgery is performed adhering to the same anatomic principles of open surgery, but without the surgeon’s hands entering into the patient’s body cavity. Specially designed endowrist instruments allow seven degrees of motion that mimic the dexterity of the human hand and wrist. The result is a better anastomosis when the bladder and the urethra are sewn together after removal of the prostate. Thus the quality of open surgery is achieved without giving a big surgical incision and its associated complications. In fact, during robotic surgery, a high-resolution 3-D vision along with 10-12 folds magnification provides true-to-life view of the surgical field and gives the surgeon an excellent visualization and details of the prostate gland and the surrounding neurovascular structures, allowing for precise dissection of the prostate and suturing of blood vessels.

The average length of surgery is 2.5 – 3 hours but it varies from patient to patient (2.5 - 4,5 hours) depending on the size of the prostate gland, shape of the pelvis, weight of the patient, and presence of scarring or inflammation within the pelvis due to infection or prior abdominal/pelvic surgery.

Blood loss during robotic prostatectomy is routinely less than 300 cc. Transfusions are rarely required. Donation of blood prior to surgery for autologous blood transfusion can be arranged if the patient desires, but is not recommended.

Pain: Another advantage of robotic surgery is much less pain compared to open surgery. Immediate post surgery pain medication can be controlled and delivered by the patient via an intravenous patient-controlled analgesia (PCA) pump or by injections by the nursing staff. Minor transient shoulder pain may be experience related to carbon dioxide gas used to inflate the abdomen during surgery.

Bladder spasms are experienced after prostatectomy as a cramping sensation in the lower abdomen. These spasms are transient and decrease over time. If severe, medication can be prescribed by your doctor to decrease such episodes.

Gas Cramps :- You may experience sluggish bowels and gas cramps for initial 2-3 days after surgery. Pain medications and effect of anesthetic drugs also prolong the recovery of bowel functions. Getting out of bed, walking, more fluids and stool softeners help in the recovery.

Hospital Stay:- Typically a patient stays for 1-2 nights in the hospital.

Back to normal activities:- One of several advantages of robotic surgery is earlier return to normal activity. Patient is expected to get out of bed and begin walking with the supervision and help of nurse on the evening of surgery. Gradually the physical activity is increased. Walking is strongly advised. In fact, prolonged sitting or lying in bed should be avoided to decrease the risk of forming blood clots in legs.

Driving should be avoided for 2 weeks after surgery. Most patients return to full activity at an average of 3-4 weeks after surgery.

Lifting heavy weights, strenuous exercises (jogging, biking, contact sports etc) should be deferred for six weeks or until instruction by doctor.

Diet & Bowel functions Oral liquids are allowed once you recover from the effect of anesthetic drugs. It is advised to take liquids and avoid high fiber diet in the beginning (till you have a normal bowel movement). It may take 2-3 days for the intestines to recover from the surgery and anesthesia. Pain medication, decreased physical activity and dehydration may cause constipation. Therefore, pain medication should be discontinued as soon as possible. Along with lots of fluids and mild laxatives or stool softeners may help in avoiding constipation. Once you have normal bowel movements, you may return to your normal diet.

Radical Cystectomy is the gold standard treatment for muscle invasive bladder cancer. It involves removal of the bladder, prostate, seminal vesicles and surrounding fat and attachments in men, and in women, also the uterus, cervix, urethra and anterior vaginal wall. Radical surgery for bladder cancer can be performed by open surgical techniques or by newer advancements like Robotic surgery.

Robotic radical Cystectomy is the latest advancement in technique of surgical removal of bladder and pelvic lymph nodes which achieves comparable results while minimizing morbidity. In this technique, we use the da Vinci Robotic surgical system which imitates the surgeon’s movement on the operating console into fine actions inside the body. The precision of surgery results in sparing of vital but delicate nerves and tissue which in turn facilitates a faster recovery, fewer complications and a shorter hospital stay.

Some of the benefits of Robot Assisted Radical Cystectomy include:

• Minimal damage to vital nerves and tissue
• Significantly reduced morbidity
• Less blood loss
• Reduced risk of infection
• Less postoperative pain and discomfort
• Fewer noticeable scars
• Advantage of high- definition 3D visualization and robot assisted suturing for
  better anatomists

Since, the bladder is removed; you will need an alternative way of passing urine. This can be in the form of Ileal conduit or Neobladder.

Robot assisted Radical Nephrectomy is performed under general anesthesia. The typical duration of the operation is 3-4 hours.

The surgery is performed through 3 to 5 small incisions (5-12 mm) made in the abdomen. The robotic arms with its attached instruments (that includes a camera) are passed through these “keyholes”. The camera provides the surgeon a 3-dimensional, high definition, magnified view of the tissues inside the body. Various types of Endowrist instruments with capability to move in various directions allow the surgeon to precisely dissect the kidney along with the tumor and make it completely free without having to place his hands into the abdomen. The dissected kidney, its surrounding fat and sometimes the adrenal gland (if removed) are then placed in a sterile retrieval bag and removed through a small incision. The entire kidney with the tumor is then sent to the pathologist for complete examination and to evaluate for detailed histopathological diagnosis.

Robotic pyeloplasty involve the precise removal of the narrow or scarred segment of the ureter (ureteropelvic junction or UPJ) and rejoining the healthy segment of the upper ureter to the pelvis.

Robotic pyeloplasty is performed under a general anesthetic. The typical length of the operation is 3-4 hours.

The surgery is performed through 3 small (5-12mm) incisions made in the abdomen. The robotic arms with its attached instruments (that includes a camera) are passed through these “keyholes”. The camera provides the surgeon a 3-dimensional, high definition, magnified view of the tissues inside the body. Various types of Endowrist instruments with capability to move in various directions allow the surgeon to precisely dissect the junction of the ureter and kidney pelves and subsequently repair the blocked or narrow segment, without having to place his hands into the abdomen.

A small hollow tube (called a ureteral stent) is left inside the ureter at the end of the procedure to bridge and support the site of repair and help drain the kidney. This stent is kept in place for approximately 4 weeks and is usually removed in the doctor's office. Immediately after the surgery, a small drain will also be left exiting your flank to drain away any fluid around the kidney and pyeloplasty repair.

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