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Robotic Microsurgery

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Robotic Urologic Surgery

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Abstract

The use of robotic assistance during microsurgical procedures is currently being explored in the treatment of male infertility and patients with chronic testicular pain. Whether the addition of this technology would allow a corresponding improvement in outcomes as when the operating microscope was introduced in microsurgery is yet to be seen. This chapter covers new robotic microsurgical applications such as: vasectomy reversal, varicocelectomy, denervation of the spermatic cord for chronic testicular pain, microsurgical vascular anastomosis, testicular sperm extraction, and nerve graft placement during robotic radical prostatectomy. Preliminary animal studies appear to show an advantage in terms of improved operative efficiency and improved surgical outcomes. Preliminary human clinical studies appear to support these findings. The use of robotic assistance during robotic microsurgical vasovasostomy appears to decrease operative duration and significantly improve early postoperative sperm counts compared to the pure microsurgical technique. As with any new technology, long-term prospective controlled trials are necessary to assess the true cost benefit ratio for robotic-assisted microsurgery. The preliminary findings are promising, but further evaluation is warranted.

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References

  1. Silber SJ. Microsurgery in clinical urology. Urology. 1975;6(2):150-153.

    Article  PubMed  CAS  Google Scholar 

  2. Berger RE. Triangulation end-to-side vasoepididy­mostomy. J Urol. 1998;159(6):1951-1953.

    Article  PubMed  CAS  Google Scholar 

  3. Chan PT, Li PS, Goldstein M. Microsurgical vasoepididymostomy: a prospective randomized study of 3 intussusception techniques in rats. J Urol. 2003;169(5):1924-1929.

    Article  PubMed  Google Scholar 

  4. Fogdestam I, Fall M. Microsurgical end-to-end and end-to-side epididymovasostomy to correct occlusive azoospermia. Scand J Plast Reconstr Surg. 1983;17(2):137-140.

    Article  PubMed  CAS  Google Scholar 

  5. Marmar JL. Modified vasoepididymostomy with simultaneous double needle placement, tubulotomy and tubular invagination. J Urol. 2000;163(2):483-486.

    Article  PubMed  CAS  Google Scholar 

  6. Marmar JL, Kim Y. Subinguinal microsurgical varicocelectomy: a technical critique and statistical analysis of semen and pregnancy data. J Urol. 1994;152(4):1127-1132.

    PubMed  CAS  Google Scholar 

  7. Owen ER. Microsurgical vasovasostomy: a reliable vasectomy reversal. ANZ J Surg. 1977;47(3):305-309.

    Article  CAS  Google Scholar 

  8. Schlegel PN. Testicular sperm extraction: microdissection improves sperm yield with minimal tissue excision. Hum Reprod. 1999;14(1):131-135.

    Article  PubMed  CAS  Google Scholar 

  9. Schultheiss D, Denil J. History of the microscope and development of microsurgery: a revolution for reproductive tract surgery. Andrologia. 2002;34(4):234-241.

    Article  PubMed  CAS  Google Scholar 

  10. Silber SJ. Microscopic vasoepididymostomy: specific microanastomosis to the epididymal tubule. Fertil Steril. 1978;30(5):565-571.

    PubMed  CAS  Google Scholar 

  11. Thomas AJ Jr. Vasoepididymostomy. Urol Clin North Am. 1987;14(3):527-538.

    PubMed  Google Scholar 

  12. Goldstein M. Microspike approximator for vasovasostomy. J Urol. 1985;134(1):74.

    PubMed  CAS  Google Scholar 

  13. Goldstein M, Li PS, Matthews GJ. Microsurgical vasovasostomy: the microdot technique of precision suture placement. J Urol. 1998;159(1):188-190.

    Article  PubMed  CAS  Google Scholar 

  14. Marmar JL, Sharlip I, Goldstein M. Results of vasovasostomy or vasoepididymostomy after failed percutaneous epididymal sperm aspirations. J Urol. 2008;179(4):1506-1509.

    Article  PubMed  Google Scholar 

  15. Ahmed I, Rasheed S, White C, Shaikh NA. The incidence of post-vasectomy chronic testicular pain and the role of nerve stripping (denervation) of the spermatic cord in its management. Br J Urol. 1997;79(2):269-270.

    PubMed  CAS  Google Scholar 

  16. Devine CJ Jr, Schellhammer PF. The use of microsurgical denervation of the spermatic cord for orchialgia. Trans Am Assoc Genitourin Surg. 1978;70:149-151.

    PubMed  Google Scholar 

  17. Levine LA. Microsurgical denervation of the spermatic cord. J Sex Med. 2008;5(3):526-529.

    Article  PubMed  Google Scholar 

  18. Levine LA, Matkov TG. Microsurgical denervation of the spermatic cord as primary surgical treatment of chronic orchialgia. J Urol. 2001;165(6 Pt 1):1927-1929.

    PubMed  CAS  Google Scholar 

  19. Levine LA, Matkov TG, Lubenow TR. Microsurgical denervation of the spermatic cord: a surgical alternative in the treatment of chronic orchialgia. J Urol. 1996;155(3):1005-1007.

    Article  PubMed  CAS  Google Scholar 

  20. Strom KH, Levine LA. Microsurgical denervation of the spermatic cord for chronic orchialgia: long-term results from a single center. J Urol. 2008;180(3):949-953.

    Article  PubMed  Google Scholar 

  21. Thiel DD, Winfield HN. Robotics in urology: past, present, and future. J Endourol. 2008;22(4):825-830.

    Article  PubMed  Google Scholar 

  22. Kuang W, Shin PR, Matin S, Thomas AJ Jr. Initial evaluation of robotic technology for microsurgical vasovasostomy. J Urol. 2004;171(1):300-303.

    Article  PubMed  Google Scholar 

  23. Kuang W, Shin PR, Oder M, Thomas AJ Jr. Robotic-assisted vasovasostomy: a two-layer technique in an animal model. Urology. 2005;65(4):811-814.

    Article  PubMed  Google Scholar 

  24. Schiff J, Li PS, Goldstein M. Robotic microsurgical vasovasostomy and vasoepididymostomy: a prospective randomized study in a rat model. J Urol. 2004;171(4):1720-1725.

    Article  PubMed  Google Scholar 

  25. Schiff J, Li PS, Goldstein M. Robotic microsurgical vasovasostomy and vasoepididymostomy in rats. Int J Med Robot. 2005;1(2):122-126.

    PubMed  CAS  Google Scholar 

  26. Schoor RA, Ross L, Niederberger C. Robotic assisted microsurgical vasal reconstruction in a model system. World J Urol. 2003;21(1):48-49.

    PubMed  Google Scholar 

  27. Fleming C. Robot-assisted vasovasostomy. Urol Clin North Am. 2004;31(4):769-772.

    Article  PubMed  Google Scholar 

  28. Parekattil S, Cohen M, Vieweg J. Human robotic assisted bilateral vasoepididymostomy and ­vasovasostomy procedures: initial safety and efficacy trial. Proc SPIE. 2009;7161:71611L.

    Article  Google Scholar 

  29. Parekattil S, Atalah H, Cohen M. Video technique for human robotic assisted microsurgical vasovasostomy. J Endourol. 2009;24(4):511-514.

    Article  Google Scholar 

  30. Corcione F, Esposito C, Cuccurullo D, et al. Advantages and limits of robot-assisted laparoscopic surgery: preliminary experience. Surg Endosc. 2005;19(1):117-119.

    Article  PubMed  CAS  Google Scholar 

  31. Chen XF, Zhou LX, Liu YD, et al. Comparative analysis of three different surgical approaches to varicocelectomy. Zhonghua Nan Ke Xue. 2009;15(5):413-416.

    PubMed  CAS  Google Scholar 

  32. Cayan S, Shavakhabov S, Kadioglu A. Treatment of palpable varicocele in infertile men: a meta-analysis to define the best technique. J Androl. 2009;30(1):33-40.

    Article  PubMed  Google Scholar 

  33. Al-Said S, Al-Naimi A, Al-Ansari A, et al. Varico­celectomy for male infertility: a comparative study of open, laparoscopic and microsurgical approaches. J Urol. 2008;180(1):266-270.

    Article  PubMed  Google Scholar 

  34. Al-Kandari AM, Shabaan H, Ibrahim HM, Elshebiny YH, Shokeir AA. Comparison of outcomes of different varicocelectomy techniques: open inguinal, laparoscopic, and subinguinal microscopic varicocelectomy: a randomized clinical trial. Urology. 2007;69(3):417-420.

    Article  PubMed  Google Scholar 

  35. Shu T, Taghechian S, Wang R. Initial experience with robot-assisted varicocelectomy. Asian J Androl. 2008;10(1):146-148.

    Article  PubMed  Google Scholar 

  36. Oliveira RG, Camara C, Alves Jde M, Coelho RF, Lucon AM, Srougi M. Microsurgical testicular denervation for the treatment of chronic testicular pain initial results. Clinics (Sao Paulo). 2009;64(5):393-396.

    Google Scholar 

  37. Cocuzza M, Pagani R, Coelho R, Srougi M, Hallak J. The systematic use of intraoperative vascular Doppler ultrasound during microsurgical subinguinal varicocelectomy improves precise identification and preservation of testicular blood supply. Fertil Steril. 2010;93:2396-2399. Epub Mar 5 2009.

    Article  PubMed  Google Scholar 

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Acknowledgments

We would like to thank Dr. Hany Atalah, Katy Lyall, Andrew Hunt, David Regan, Dr. Rachana Suchdev, Intuitive Surgical Inc., and Vascular Technology Inc. for their continued support in the pursuit and refinement of robotic microsurgical techniques and tools.

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Authors and Affiliations

  1. Department of Urology, University of Florida, Gainesville, FL, USA

    Sijo J. Parekattil M.D.

  2. Department of Urology, University of Florida Affiliated Hospitals, Gainesville, FL, USA

    Marc S. Cohen M.D.

Authors
  1. Sijo J. Parekattil M.D.
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  2. Marc S. Cohen M.D.
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Editors and Affiliations

  1. Florida Hospital Celebration Health, Global Robotics Institute, Celebration Place 410, Celebration, 34747, Florida, USA

    Vipul R. Patel

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© 2011 Springer-Verlag London Limited

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Parekattil, S.J., Cohen, M.S. (2011). Robotic Microsurgery. In: Patel, V. (eds) Robotic Urologic Surgery. Springer, London. https://doi.org/10.1007/978-1-84882-800-1_43

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  • DOI: https://doi.org/10.1007/978-1-84882-800-1_43

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  • Publisher Name: Springer, London

  • Print ISBN: 978-1-84882-799-8

  • Online ISBN: 978-1-84882-800-1

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