Urological robotic surgery for the treatment of malignant and benign conditions

When medication and other non-surgical treatments are unable to relieve symptoms, surgery may be recommended as a treatment option. At MedStar Washington Hospital Center, our urology specialists perform minimally invasive robotic surgery using the da Vinci® surgical system.

The da Vinci surgical system allows physicians to perform minimally invasive procedures through small incisions using robotic technology. The robot's unique EndoWrist instruments offer physicians the dexterity not available to them when using conventional laparoscopic instruments.

By offering the surgeon, urologist, or oncologist a high-definition 3-D view, the da Vinci surgical robot allows physicians to better distinguish and preserve vital muscles and delicate nerve tissues surrounding the operative area.

Retzius-sparing robotic prostatectomy

Retzius-sparing robotic prostatectomy, an innovative surgical approach to treat men with prostate cancer, has shown to significantly reduce the risk of urinary incontinence, or urine leakage, and also improve patient’s quality of life without compromising oncological outcomes, according to a new study led by Keith Kowalczyk, M.D., director, Urologic Oncology at Medstar Georgetown University Hospital. Only the 3rd of its kind in the United States, this study examined data gathered from 140 radical prostatectomies performed by Dr. Kowalczyk over a 4-year period at MedStar Georgetown University Hospital.


The findings show that, in comparison to standard robotic prostatectomy, men undergoing Retzius-sparing robotic prostatectomy had higher rates of continence (98% vs. 81%), achieved continence earlier (49 vs. 64 days), and demonstrated 80% lower risk of suffering from incontinence one year following surgery. Additionally, men undergoing Retzius-sparing prostatectomy had significantly better overall quality of life one year following surgery.

Urinary incontinence and compromised quality of life following a radical prostatectomy has been a barrier to seeking appropriate care for some prostate cancer patients. “We tend to underestimate the effect that even mild urine leakage may have on patient’s quality of life and well-being following prostatectomy. That is why I decided to learn this new technique, even though it is technically very challenging. I am glad that I did because I have seen a remarkable improvement in outcomes for my patients as seen in this study,” Dr. Kowalczyk said.

Following robotic prostatectomy, most patients were able to leave the hospital less than 24 hours after surgery and resume routine activities in 1–2 weeks. Additionally, patients undergoing Robotic surgery tend to have less pain and discomfort following the surgery, translating to a minimal need for pain medications during hospitalization and no need for narcotic pain medications at home. Sean Hawkins, a patient who underwent the surgery said, “After about 3 weeks I regained all of my functions and ended up going back to work earlier than I expected, I got my life back totally.”

“Robotic surgery allows for a much more precise surgery with much easier recovery and less blood loss for the patient,” said Dr. Kowalczyk. “With Retzius-sparing robotic prostatectomy, the whole surgery is done in a very small space in the pelvis which is not accessible during traditional open surgery. This allows us to leave as much as the normal pelvic anatomy intact as possible without causing surrounding damage, which is most likely what leads to these improved outcomes.”

Medstar Georgetown University Hospital acquired the DaVinci Xi Dual Console robot in February 2020, and Dr. Kowalczyk has started performing the surgeries on this platform. The state-of-the-art surgical system offers a minimally-invasive option for patients who require a prostatectomy. The new technology uses fine instrumentation, 3-D visuals, increased magnification, and only requires a less than ½ inch incision. In addition, the DaVanci Xi platform allows improved visualization and improved movement of instrumentation. “Using the Xi platform has made this surgery much easier for me, for sure.” said Dr. Kowalczyk.

Beneficial treatments using robotic surgery

Prostate cancer

Prostate cancer is the most common cancer in men not involving the skin. Often times, men won’t notice any health problems, as prostate cancer tends to grow slowly. The treatment for prostate cancer is dependent on the patient’s specific diagnosis. Your physician will work in conjunction with you to decide which treatment option is best.

Robotic-assisted laparoscopic radical prostatectomy is the most common robotic surgery performed by the Urology Department at the Hospital Center. During the procedure, the prostate gland and the seminal vesicles are removed. This treatment is highly precise, contributing to its reputation as the standard of care for prostate cancer surgery.

Bladder cancer

The bladder is a hollow muscular organ located in the lower part of the abdomen that collects and stores urine from the kidneys until it is passed out of the body. Typically, blood in the urine is the first indication of bladder cancer. However, bladder cancer may also cause a constant urge to urinate —even when the bladder is empty. These symptoms may also be related to non-cancerous conditions. For this reason, if you experience any of these symptoms, it is important to speak with your doctor.

Robotic-assisted cystectomy is a minimally invasive surgical method for the treatment of bladder cancer. This procedure offers bladder cancer patients the prospect of a more effective surgery and less problematic post-surgical recovery. Minimally-invasive, robotic technology allows surgeons to make smaller incisions, which spare vital, but delicate, nerve and muscle tissue. Following a robotic cystectomy procedure, patients experience a shorter hospital stay, fewer complications, and a faster recovery time.

The treatment for bladder cancer is dependent on the patient’s specific diagnosis. Your physician will work in conjunction with you to decide what treatment option is best.

Kidney cancer

Each year, more than 50,000 individuals are diagnosed with kidney cancer . For many, kidney cancer is discovered when imaging procedures are performed for other conditions. For some, abdominal pain, back pain, or anemia may indicate the presence of kidney cancer.

Robotic-assisted laparoscopic partial nephrectomy delivers the efficacy of open surgery with a safe method for removing small renal tumors, while preserving surrounding kidney tissue. Using a near-infrared camera and a benign tracer that is injected into the blood, surgeons are able to see the blood supply to the kidney and tumor, as well as differentiate cancerous tissue from normal kidney tissue. This allows for better control of the kidney's blood supply, potentially less injury to the area surrounding the kidney, and limits the risk of leaving any tumor behind.

This minimally invasive technique leaves patients with less discomfort and allows them shorter hospital stays, earlier return to daily activities, and smaller incisions.

Upper urinary tract reconstruction

There are benign conditions of the upper urinary tract that may require reconstruction. These conditions include ureteropelvic junction obstruction and ureteral obstruction.

Ureteropelvic junction (UPJ) obstruction

Ureteropelvic junction obstruction is a condition where a blockage occurs where the ureter (the tube that drains urine from the kidney to the bladder) and the kidney meet. This blockage may cause urine to build up in the kidneys.

Robotic-assisted laparoscopic pyeloplasty is a minimally-invasive procedure used to repair congenital or acquired narrowing or scarring of the ureteropelvic junction. During pyeloplasty, the obstruction is removed and the urinary tract is then reconstructed. Damage caused by the build-up of fluid pressure is repaired before the ureter and the kidney are sutured back together.

This minimally invasive procedure incorporates the same efficacy and safety as open surgery with less post-operative pain, a shorter hospital stay, and earlier return to work and daily activities.

Ureteral obstruction

Ureteral obstruction may be acquired in situations where a blockage in the ureter prevents urine from passing easily from the kidney into the bladder. Additionally, a ureteral obstruction may occur due to the ureter having been damaged during a surgery in the abdomen or after gynecologic surgery.

If the ureter is damaged, it may be possible to reattach the ureter to the bladder with ureteral reimplantation. The Hospital Center's state-of-the-art da Vinci® robotic Surgical System allows doctors to perform a precise, minimally invasive procedure through a few tiny incisions with enhanced vision, dexterity, and control.

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