The da Vinci Xi - Robot-assisted system for minimally invasive urological surgery

The urinary system is crucial to the body as it filters the blood, removing waste and excess water. Urologic diseases affect parts of the urinary system which includes the kidneys, renal pelvis, ureters, bladder, prostate gland and urethra. The severity widely varies, ranging from mild to serious conditions, e.g. prostate cancer and kidney cancer. Although the prostate gland belongs to the male reproductive system, prostate issues can cause a raft of urinary problems, particularly prostate cancer. Life-threatening conditions, such as bladder cancer and kidney cancer as well as prostate cancer often require an effective surgery conducted in a timely manner to improve the treatment success rates. Medical advances in urological surgery have accelerated the pace of changes, offering an amazing cooperation between urological surgeons and technology, through which surgeries reach high levels of precision and efficiency. A cutting-edge robotic system, the da Vinci Xi is designed to accommodate and seamlessly integrate a range of current technologies in surgical areas, including intraoperative imaging, advanced instruments and anatomical access, enabling the surgeons to perform minimally invasive procedures in hard-to-reach areas through small incisions. Indeed, the use of the da Vinci Xi is associated with less pain and a shorter operative time with an improved patient’s quality of life.

Advances in urological surgery

In the past, conventional or open surgery in urology involves making a large incision which allows the surgeon to reach and operate the affected area, leading to profound pain and prolonged recovery time. As minimally invasive urological surgery emerged, laparoscopic urological surgery has become a preferred treatment option for several conditions. During laparoscopic urological surgery, the surgeons use a laparoscope – a thin rod with a camera attached at the end to visualize the surgical site through small incisions, resulting in less pain and faster recovery time. The da Vinci system is an advanced robotic technology designed to enable surgeons to perform a minimally invasive urological surgery with enhanced surgical precision and safety. Robotic arms are capable of free movements of nearly 360° on seven axes, thereby improving access to anatomically challenging or hard-to-reach areas while shortening operating time and minimizing postoperative complications caused by bleeding. Mounting evidence suggests that robotic-assisted surgery using the da Vinci Xi is considered a viable approach for prostate cancer as it yields advantages including reduced blood loss and shorter recovery with a quick return to daily life. Nevertheless, whether robotic-assisted surgery is a treatment of choice for each individual, the consideration will be made hinging upon patient’s condition and disease severity that might widely vary among individuals. 

What is the da Vinci Xi?

The da Vinci Xi is an advanced robotic surgical system using specialized technology that enhances the capabilities of surgeon’s hands. Controlled by surgeon, four surgical arms consisting of tiny instruments with wrists at the tip allow surgeons to perform procedures in difficult-to-reach or complex areas with precise movements, enhanced magnification and better dexterity within the deep and narrow confines of the urinary system. A special high-definition camera attached provides magnified 3D views of the operating area, leading to high degree of surgical accuracy and patient’s safety. For every movement, the surgeon makes at the console standing next to the surgical arms. The da Vinci robot replicates every move inside patient’s body on a smaller scale. The surgeon has complete control during the entire procedure. 

Robotic-assisted surgery using the da Vinci Xi has been widely deployed in urological surgery due to a better access to anatomically challenging organ. More importantly, it can substantially increase the survival rates of patients diagnosed with certain urological cancers. 

What are urological conditions that can be treated with the da Vinci Xi?

The da Vinci Xi has been effectively applied to the surgical treatment of prostate and urological diseases, such as: 

• Prostate cancer: Prostate cancer is often found in men with advancing age. Prostate cancer develops when abnormal cells form and grow in the prostate gland. If left undiagnosed or untreated, cancer cells can further spread (metastasis) to lymph nodes and other organs such as bone, reaching an advanced stage. Common warning signs that potentially indicate prostate cancer include trouble urinating, difficulty starting urination, decreased force in the stream of urine and blood in the urine. If cancer has spread to the bone, patients often experience bone pain or fractures that compress the spinal cord. One of the main treatment modalities to treat prostate cancer is prostate surgery (prostatectomy) to remove the entire prostate gland. Robotic-assisted radical prostatectomy using the da Vinci technology allows the surgeon to clearly visualize the affected area within the deep and narrow confines of the prostate and surrounding organs. Due to an enhanced dexterity and magnified images, urinary structures, e.g. nerves and sphincters can be preserved, resulting in a better urinary control after surgery and faster recovery. To treat prostate cancer effectively, early detection is the key, enabling a timely treatment before it spreads to other organs.  
• Kidney cancer: Kidney cancer develops when cells in the kidneys change and grow out of control. Without proper treatment, it can spread to other organs, e.g. lung and bone. Kidney cancer is often asymptomatic, especially in the early stage. However, patients with advanced stage might experience blood in the urine, mass in the abdomen, flank pain and vomiting blood. In metastatic stage to the bone, fractures might possibly happen. Main treatment approach is kidney removal surgery, either removing whole kidney (nephrectomy) or removing the cancer but leaving as much of the kidney as possible (partial nephrectomy). Since the kidneys are situated deeply below the diaphragm and close to the large blood vessels, robotic-assisted partial nephrectomy enables the surgeon to reach the surgical site with greater range of motion, ensuring that the maneuvers made by the surgeon are safe and precise in all angles. Moreover, high surgical precision results in less damages to surrounding tissues and organs around the kidneys while reducing infection rates. In addition, in case partial nephrectomy is required in which only the tumor is removed and healthy kidney tissues are spared, the da Vinci Xi makes it possible for the surgeon to quickly operate and reduce clamping time, therefore minimizing the chance of renal ischemia which is vital for preservation of overall renal function.    

What are advantages of the da Vinci Xi for minimally invasive urological surgery?

The fourth generation of the da Vinci system yields benefits, including: 

• Better access: Robotic arms are capable of free movements of nearly 360° on seven axes, thereby improving access to anatomically challenging or hard-to-reach areas in the urology system.  
• More precise surgery: Surgery can be carried out efficiently since the robotic arm’s movements are highly precise with greater range of motion, ensuring that the maneuvers made by the surgeon are safe and precise in all angles.
• Improved visualization: A sophisticated camera provides magnified,3D high-definition views of the surgical area with a better visualization of vessels, nerves and muscles nearby, resulting in less complications caused by damages to the surrounding areas. 
• Improved survival rates: Higher degree in surgical precision helps minimize postoperative complications and increase the survival rates of patients with certain urological cancers. 
• Restored urinary continence: A sophisticated robotic surgery system enables a greater chance of having nearly normal urinary control due to preserved sphincter function regulating involuntary urine flow.
• Faster recovery: Due to small incisions, patients often experience less pain, shorter hospital with a quick return to daily life.