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NARUS 2019: Robotics for Reconstructive Urology: Pushing the Envelope

Las Vegas, Nevada (UroToday.com) Dr. Lee Zhao, a reconstructive urologist from NYU Langone Health Center presented on the usage of robotic urologic reconstruction. Dr. Zhao demonstrated in his talk that the concepts of urologic reconstruction can be pushed further and be utilized in procedures that have been thus far deemed not acceptable as robotic urologic reconstructive cases.

Dr. Zhao’s practice includes robotic urethral reconstruction, bladder reconstruction, posterior urethroplasty, fistula repair, intracorporeal urinary diversion, and transgender robotic surgery.

Reconstructive urologic surgery is difficult due to a multitude of reasons:
  1. Prior surgery distorts normal anatomy
  2. Difficult exposure
  3. Poor blood supply because of prior radiation or surgery
  4. Reproducibility is an issue because the cases are uncommon
Robotic surgical systems can be used to help reconstructive urologic surgery by reducing postoperative pain, and decreasing the long-term sequelae from the incisions. Furthermore, the robot improves the visualization and reach of the surgeon, with surgical 3D vision beyond the naked eye, fewer limitations due to inaccessibility of the anatomy, 7 degrees of freedom, motion scaling,  and tremor reduction. Lastly, the robot enables recording of the case which enables review and training.

Aside from the advantages of the robot as an incredible tool, the surgeon is also extremely important. The surgeon should work using an approved algorithm and demonstrate a good treatment plan, sound judgment, disease knowledge, and dexterity. Surgery could be made to look easy when there are easily identifiable anatomy, good visibility and exposure, precise suture placement and predictable outcomes.

Dr, Zhao mentioned several reconstructive cases where the robot has a clear advantage over an open procedure. These include fixing ureteric obstruction such as urethral stricture, using buccal graft for urethral reconstruction, and non-transecting ureteral reconstruction to the bladder. Other procedures include retrovesical space dissection for fistula repair and vaginoplasty, and sphincter-sparing transabdominal reconstruction or deep pelvic reconstruction.


Presented by: Lee Zhao, MD, board-certified urologist in NYU Langone Health, New York, New York

Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre @GoldbergHanan at  2019 3rd Annual North American Robotic Urology Symposium (NARUS), February 8-9, 2018 - Las Vegas, Nevada, United States