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Robotic Assisted Surgery

Robot-assisted laparoscopic surgery with The da Vinci Surgical System entails the use of a surgical robot to allow surgeons to offer their patients the benefits of laparoscopic surgery. The use of this technology helps the surgeon perform more complex operations without the need for a large incision. By combining robotics and state-of-the-art computer technology, surgeons can operate with improved vision, greater dexterity and control than with traditional surgical approaches. The machine works by translating the surgeon’s hand movements into precise movements of the surgical instruments, which allows the surgeon complete control throughout the procedure.

 

Intuitive Surgical, USA, introduced The da Vinci Surgical System in 2002 and it is regarded as the leader of robotic surgery. Life Kingsbury Hospital has acquired the da Vinci X, a first of its kind in Africa.

What are the benefits of robotic surgery?

With robot-assisted surgery, patients can have major surgery with only a few tiny incisions. 

 

Compared to open surgery some additional benefits include:

  • Significantly less pain and analgesia needs.

  • Less blood loss and much fewer blood transfusions.

  • Fewer complications and lower risk of infection.

  • Shorter hospital stay.

  • Faster recovery and return to normal activities.

  • Small incisions for minimal scarring.

  • Improved urine continence and sexual function recovery after robotic prostatectomy.

 

Benefits of the system for surgeons include 3D HD vision, 10x magnification view, great ergonomics, improved dexterity, improved access and greater surgical precision.

 

Which operations are commonly performed with The da Vinci Surgical System?

  • Robotic assisted prostatectomy (for prostate cancer treatment).

  • Robotic assisted laparoscopic pyeloplasty (repairing a blockage of the ureter).

  • Robotic assisted partial nephrectomy (removing a small tumour from the kidney).

Robotic Prostatectomy

Robotic prostatectomy is a minimally invasive procedure that is performed for the treatment of prostate cancer. Your surgeon is likely to recommend the procedure if there is cancer inside the prostate gland that hasn’t spread to the surrounding organs and tissue. In most cases a bilateral nerve sparing prostatectomy will be performed to ensure return of your sexual function after the surgery. In some cases, structures close to the prostate gland may also need to be removed to ensure that the cancer is completely removed.

 

During the procedure, your surgeon will make tiny incisions in the abdomen. With the use of a surgical system, the prostate is removed in a small bag through one of these small cuts. The bladder is sutured back onto the urethra and a catheter is inserted into the urethra to help drain urine while your body heals, usually for a period of five days after the surgery. Most patients go home on the first or second post-operative day.

 
 
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Urinary Calculi (kidney stones)

The kidney is a bean-shaped organ and roughly the size of a large fist. It is located just below the rib cage, and there is one on each side of your spine. The kidneys filter blood, remove waste products from the blood, and excrete extra water in the form of urine. 

 

Kidney stones are hard substances made of salt and minerals that crystallise out from the urine and are formed inside the kidneys. These “stones” grow bigger and eventually break free from the inside of the kidney. They can then pass down the ureter and often cause a blockage, which results in severe pain.

 

Risk factors

There is no one single cause of kidney stones, but there are definitely factors which put you at high risk of getting kidney stones. Some risk factors include: 

  • A personal or family history of having kidney stones.

  • Living in a hot geographical area.

  • Dehydration.

  • High protein, high salt, high sugar diet.

  • Obesity.

  • Digestive diseases such as inflammatory bowel diseases.

  • Previous surgery to your kidneys.

  • Abnormal urinary tract.

 

Investigating kidney stones

  • The diagnosis of a ureteric calculus is usually a clinical diagnosis made by your general practitioner or the emergency room doctor.

  • Imaging such as CT scan and ultrasound of the renal tract confirms the diagnosis.

  • Analysis of passed stones can help determine cause of the kidney stones.

  • Blood tests are usually done to evaluate kidney function.

 

Symptoms

You should see a urologist if you experience any of the following symptoms:

  • Severe pain on one side of the back, below the ribs, often spreading around the abdomen to abdomen and groin.

  • The pain typically comes in waves and fluctuates in intensity, often associated with nausea and vomiting.

  • Pink, red or brown urine may indicate blood in the urine, due to the stone.

  • Urgent need to urinate and abnormal frequent urination may indicate an infection or a stone near the bladder.

  • Fever and chills suggest an infection and require urgent medical care.

 

Kidney stones treatment

The type of treatment depends on many factors, involving the patient, how ill they are, where the stone is positioned and how large the stone is. Your urologist is an expert at managing all kinds of kidney stones. As treatment for kidney stones, your urologist may suggest one of the following treatment options:

 

  • Retrograde intrarenal surgery (RIRS): Ureteroscopy involves the passage of a thin telescope through the bladder to the ureter in order to visualise the kidney stone in the ureter or kidney. Laser lithotripsy is the use of a special surgical laser to fragment the kidney stone into pieces that are small enough to remove via the ureter (which is a very narrow tube). 

  • Percutaneous Nephrolithotomy (PCNL): A PCNL is performed under general anaesthesia through 1cm skin incision in the back, over the kidney. A small telescope and other instruments are inserted through an access sheath and the stones are removed through this working channel. It is mostly performed for large kidney stones.

  • Extracorporeal Shock Wave Lithotripsy (ESWL): The surgeon uses a special X-ray machine to focus shock waves on the kidney stone. These shock waves break down the crystalline structure of the kidney stone and it slowly crumbles into small fragments over several weeks. These fragments are then passed naturally down the ureter. This is performed under anaesthesia but is a non-invasive form of treatment.

  • Laparoscopic pyelolithotomy: Laparoscopic pyelolithotomy is a minimally invasive procedure (keyhole surgery) offered as an alternative to the PCNL procedure. It is useful only in certain kidney stones, but has the advantage that the stone is often removed without breaking it into pieces.

  • Open stone surgery: Your urologist makes an incision on your side to remove very large kidney stones, which have no other way of being removed. Nowadays, we very seldom perform open surgery for urinary calculi.

 
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Haematuria (blood in urine)

Haematuria is the presence of blood in your urine. This may be visible to the naked eye or non-visible (for example when it is detected by a urine dipstick or urine microscopy). It is not normal for blood to be present in your urine. It may indicate that there is a possible problem with your urinary tract: kidneys, ureter, bladder or urethra.

Symptoms

While the actual cause of prostate cancer is unclear, there are some factors which may put you at high risk of getting prostate cancer. They include age (the older you are, the more at risk you are), race (African-American men have a higher risk of prostate cancer and are most likely to have the most aggressive form). Other risk factors include family history (if you have a history of men in your family who have had prostate cancer or family members with breast cancer, then you have a higher risk of getting prostate cancer).

Investigation for haematuria

Your urologist will conduct the following tests to find the cause for blood in your urine, and exclude sinister pathology:

 

  • Urine tests

  • Imaging tests: The use of ultrasound, CT or MRI scans.

  • Cystoscopy: This is a camera test of the bladder using a cystoscope via your urethra. It can be done under local or general anaesthesia

  • Blood tests.

 
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Bladder Cancer

The bladder is a balloon made of special muscles, located in the pelvis, just behind the pubic bone. It’s function is to store urine until you pass urine, when it contracts and empties. Cancer of the bladder arises in the specialised urothelial cells which line the inside of your bladder, and often present as a polyp in the bladder. Most bladder cancers are easily treated if detected early enough.

Risk factors 

You are at particular risk of bladder cancer if you are a smoker, of an advanced age, or if you experience chronic bladder inflammation. Some industries where you are exposed to chemicals such as those used in the printing, rubber, leather, textiles and paint industries, can increase your risk of developing a bladder tumour.

Symptoms

The most common sign of bladder cancer is painless passing of blood in the urine. Other symptoms may mimic those of a bladder infection and therefore, should be checked out by your urologist as a precaution.

Investigating suspected bladder tumours:

  • Cystoscopy: A telescope test to look at the inside of your bladder

  • Biopsy: Taking samples through the telescope

  • Ultrasound: To evaluate the kidneys and the bladder

  • Urine cytology: Microscopic analysis of the urine

  • Specialised imaging tests: For example CT scan

Bladder cancer treatment 

Initial diagnosis and treatment is performed endoscopically under anaesthesia. After diagnosis and staging is complete, definitive treatment options will be discussed:

  • Minimally invasive transurethral resection of bladder tumours: Under general anaesthesia, your urologist removes the tumour in your bladder through the urethra using a special cystoscope and camera. Biopsies (pieces of the removed cancer) are then sent to the laboratory for analysis.

  • Surveillance cystoscopy: Our urologists follow a strict surveillance protocol after treatment of all bladder cancer. A cystoscopy is very effective at detecting recurrent bladder cancer. Our team of specialists monitors your progress through periodic check-ups. 

  • Bacille Calmette Guerin (BCG): A very successful type of immunotherapy used in early, but aggressive, bladder cancer is BCG. A solution instilled through a catheter into your bladder stimulates your immune system to allow the body to fight against the growth of cancerous cells. After BCG treatment, the chances of recurrent bladder cancer are less. This is done on a weekly basis in your urologist’s rooms.

  • Intravesical chemotherapy: heated chemotherapy called Mitomycin C is sometimes administered directly to the bladder using a special catheter system called HIVEC.

  • Radical cystectomy: In advanced and aggressive cases, the bladder may need to be completely removed in a surgical procedure called a radical cystectomy. This procedure involves removal of your bladder together with the surrounding lymph nodes, usually through an incision. Afterwards, your urologist will reconstruct your urinary tract so that you are still able to urinate. This is done through a procedure known as a urinary diversion (a stoma for draining urine) or neobladder formation, during which your urologist creates a new bladder using your intestine. 

  • Neo-adjuvant chemotherapy: Chemotherapy may be used before surgery to “shrink” tumours prior to an operation.

  • Chemotherapy: Used in advanced bladder cancer.

  • Radiation therapy: This form of treatment is sometimes used in advanced bladder cancer.

  • Immunotherapy: Immunotherapy triggers the body’s immune system to fight the cancer cells. Immunotherapy also termed “biological therapy” helps your body fight against cancer. This form of treatment can be used in advanced or metastatic bladder cancer.

 
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Kidney Cancer

The kidneys are two bean-shaped organs, slightly larger than a fist, located under the rib cage on either side of your spine. Tumours of the kidneys may arise from various parts of the organ, and may lead to malignant tumours such as renal cell carcinoma, urothelial carcinoma, sarcoma or Wilms’ tumour.

 

Screening for and investigating kidney cancer 

Your urologist will usually perform an ultrasound to screen for renal tumours. In reality, most tumours are found during special diagnostic imaging for other compliant states. We may need additional imaging such as CT scans and MRI scans to characterise the lesion. You will also undergo blood tests. Sometimes a biopsy is not indicated.

Symptoms 

In the early stages of kidney cancer, renal tumours are completely asymptomatic. In more advanced cases, patients may present with blood in the urine.

Kidney cancer treatment options 

The urologists at Cape Urology provide all forms of recognised surgical treatment of renal tumours. They may also refer you to a specialist oncologist should additional treatment be needed. Various procedures for treatment of renal tumours are possible, these include:
 

  • Focal treatment using radio-frequency ablation of the tumour: a procedure performed under sedation, when the tumour is destroyed using heat generated by a special needle which is placed into the lesion/tumour under CT guidance. This is done in the X-ray department.

  • Laparoscopic radical nephrectomy: Using key-hole surgery with a camera (laparoscope) via small incisions in the abdomen, your urologist will remove the entire kidney and some of the surrounding tissue. The kidney is removed through a small incision in the groin and sent for analysis.

  • Laparoscopic partial nephrectomy: Using key-hole surgery with laparoscopic instruments, the urological surgeon will remove only tumour with a small amount of surrounding tissue, preserving the rest of the normal kidney.

  • Robotic-assisted partial nephrectomy: The same procedure as above, except that the laparoscopic instruments are manoeuvred with the help of the Da Vinci robotic surgical system.

  • Laparoscopic nephroureterectomy: Using the same minimally invasive laparoscopic surgery, we remove the kidney together with the ureter along with a small piece of the bladder. This is necessary only for certain types of tumours.

  • Open renal oncological surgery: In cases where minimally invasive surgery cannot be done or is deemed to risky, an open incision is made to remove the organ.