Transitioning from microsurgery to robotic microsurgery in reproductive urology
Epublication WebSurg.com, Apr 2014;14(04). URL: http://websurg.com/doi/lt03enkavoussi001
For years, people have been dreaming of robots. Whether for science fiction or for practical use, the idea of a robotic system to mechanically assist us with tasks has been sought after. We used to hear people say “someday robots will perform surgery for us”. It is not necessarily the case, but robots are certainly finding more utility in assisting us with different types of surgery. The da Vinci® system began with uses for gross surgical procedures and has expanded its utility to microsurgery. In urology, this particularly lends itself to fertility surgery. This technology is primarily useful for vasectomy reversal and varicocelectomy in the realm of reproductive urology. Surgery that we initially tried with the naked eye, advanced through multiple technologies including optical loupes, operative microscopes, and now the operative robot. The advantages of using robotics to assist with microsurgery in reproductive urology include the robotic endowrists allowing for seven degrees of freedom, which allow for movements that the human hand and wrist cannot make, an ergonomic design for the surgeon which is less fatiguing than an operative microscope which may enhance performance, and high definition 3D optimal visualization of a microsurgical field. The ability to stop operating for a few seconds and to take a breath during challenging microsurgical cases also allows for an unchanged operative field once the surgeon resumes work unlike the operative microscope. Once the learning curve for robotic microsurgery has been mastered by microsurgeons it should improve operative times as well. My data on robotic vasectomy reversal shows comparable outcomes with robotic microsurgery, even in my very early case series, proving the feasibility of transitioning from pure microsurgery to robotic microsurgery for a formally trained microsurgeon.