Technological Advancements in Urology - Research Paper Example

?Introduction Technological advancements have continued to influence the current practices of urology, such as the utilization of robot surgery. Since the concept was first publicized in 2001 as a means of assisting radical prostatectomy, robot-assisted surgery has gained considerable attention in its application for urologic procedures. Over 60,000 radical prostatectomies that have been assisted by robots were carried out in 2009 alone (Raynor and Pruthi, 2010). The nature if such procedure, such as its minimal level of invasiveness, has resulted to increased precision, decreased occurrences of blood loss, shorter duration of hospital stay, decrease in morbidity, as well as a shorter period of recovery. In addition, the use of robotic surgery has been further developed even beyond prostatectomy as it has integrated a wide range of procedures, such as nephrectomoy, cystectomy, urinary tract surgery, and adrenalectomy, to name a few. Robotic surgery has also been widely accepted in pediatric urologic procedures. This paper then attempts to point out existing research that has delved into robotic surgical applications particularly those on urologic procedures as well as their relevance and possible advancements. Discussion In the research conducted by Tollefson, Frank, and Gettman (2011) to examine the occurrence of and morbidity rate of surgical site infections or SSI when patients undergo prostatectomy. They also aimed to determine its link with the used surgical approach. The occurrence of SSI after undergoing radical prostatectomy has been associated with an increase in costs as well as morbidity rates. Furthermore, comparisons between robotic-assisted and open surgery have been conducted with which modern robotic experience was compared with previous cohorts experiencing open surgery. Tollefson et al. (2011) reviewed the occurrence of SSI among 5,908 patients who experienced retropubic radical prostatectomy (4,824 patients) and robotic-assisted prostatectomy (1,084 patients) during the period from 2004 to 2008. Review of patient records was also conducted in relation to SSI development and treatment with which SSI was particularly described as a wound erythema that must be treated with antibiotic therapy. This may also refer to an open wound caused by surgery that usually develops within 30 days after the procedure. According to the results, while 3.7% of the patients undergoing prostatectomy developed SSI, individuals who underwent RARP (o.6%) were less likely to experience SSI compared to those who underwent RRP (4.5%). In addition, SSIs among patients who experienced the RARP was treated in a quicker manner (within 7 to 16 days) and was expected to require minimal wound incision and drainage. They were also less likely to be readmitted to the hospital or undergo another operation for debridement. On the whole, patients who experienced RARP can be less expected to develop SSI compared to those who had been undergoing RRP. Moreover, the infections that were developed after a procedure that was minimally invasive were less severe. Hence, further examination with regards to SSI mechanisms should be carried out to contribute to the decrease of patient morbidity. This can include the important role of robotic-assisted prostatectomy in increasing favorable outcomes among patients (Tollefson et al., 2011). Rogers et al. (2011) focused on the role of robotic-assisted radical prostatectomy on elderly patients who have high-risk prostate cancer (CaP). The main goal of their study was to obtain more clarity in such robotic procedures and assess the results of elderly patients who have CaP and have preferred RARP over other procedures, such as radiation therapy. In the period between April of 2001 and November of 2009, a sample of 69 elderly patients aged 70 years and older and have high-risk CaP went through RARP at the researchers’ institution. Consequently, the outcomes were analyzed. According to the findings, a number of complications had been identified, including ileus and urine leak whereas the average stay at the hospital was 1 day and no more than 3 days. Final pathology indicated that 37.7% of the sample developed an organ-confined disease whereas biochemical recurrence was experienced by 17.4% found during the follow-up after 37.7 months. A single occurrence of positive lymph nodes was also found during the surgical procedure (1.4%). Meanwhile, the actuarial biochemical recurrence-free survival was reported at 91% after 12 months and then 86% after 36 months. Improvement in IPSS scores were also highlighted with regards to the functional outcomes as evaluated through the patient administered questionnaire for the follow-up after 26.2 months. For instance, 81.5% of the patients had been using 1 pad or less for each day for their urine control while 33.3% of the sample (21 males) had preoperatively achieved favorable erections that can be sufficient for intercourse (Rogers et al., 2011). Therefore, it was concluded that robotic-assisted surgery for urologic procedures have been proven safe and reliable in elderly patients who have high-risk prostate cancer because it was able to generate satisfactory functional and oncologic outcomes. In the study of Castle and Lee (2008), their aim was to standardize acronyms and nomenclature associated with robot-assisted procedures in urology. A review of literature with regards to robotic procedures applied in urology was carried out. Different acronyms had been queried whereas frequency of use was examined as well. Reviewed literature also included articles that focused on the on standardization of scientific nomenclature that has been applied in other health care fields. Their topic had been investigated within the newly established working group of urologic robotic surgeons (WURS). Findings indicated that there is a broad variation in the use of acronyms as well as terminology for robotic-assisted procedures for kidney and prostate surgery. However, the application of numerous terms, including, robot, robotic, robotic-assisted laparoscopic, robot-assisted laparoscopic, or robotic computer-assisted procedures applied in radical prostatectomy and pyeloplasty was inconsistent and lack of standardization was evident. As the searches and queries using terms and acronyms including RP, RRP, and RALP, to name a few, generated different publications that focused on renal and prostate procedures, it is of great importance to standardize the nomenclature that is applied to robotic surgery in urology. As robotic literature remains fundamental and continues to develop, it was recommended by the Scientific Committee of the Working Group of Urologic Robotic Surgeons to make use of the term "robot assisted" to the current nomenclature used to refer to open procedures. Making use of consistent and standardized terminology for procedures that are carried out with robots can help organize literature search as well as facilitate possible research efforts for the coming years. The important function of the standardized nomenclature applied for billing purposes also remains evident (Castle and Lee, 2008). In the study conducted by Patel (2008), it was emphasized that certain countries, particularly India, may not be prepared yet for robot-assisted surgery. Conditions in the United States and India were compared, placing an emphasis on the significant difference evident between the two nations. For instance, the US have had more than 400 robots assisting in urologic procedures whilst their utilization rates continue to increase on annual basis. India, however, has 5 robots which are being utilized in different specialties while the urologists in the country are still uncertain as to when urologic procedures will be continuously assisted by robots. The study also highlighted the benefits of robotic technology, such as being able to provide patients with a surgical alternative that is less invasive compared to traditional procedures. For individuals who have acquired laparoscopical training, robot-assisted surgery has provided them with a platform for conducting operations at a higher level. In India, the development of robotic technology has taken place although it has not yet fully developed owing to the lack of technological accessibility among hospitals and inadequate educational opportunities. Hence, the slow expansion of robotic technology in the country has been greatly associated with costs. Although young health professionals in India have demonstrated great interest in the use of such technology, there is still a need to provide access to a wide range of medical technology along with the provision of training that will prepare them for the most current practices and procedures. It is also suggested that evidence-based evaluation to examine technological equipment and facilities in medical centers and hospitals should also be carried out particularly those that employ laparoscopic procedures and focus on prostatectomy. This way, the needs of surgeons and medical team members are identified. It has then been concluded that Indian urologists be formally educated and prepared for the latest use of technology whilst alternatives are taken into consideration which can be appropriately applied in an evidence-based approach. Consequently, this can yield favorable opportunities for the success of surgeons and safety of patients (Patel, 2008). Conclusion According to the studies reviewed, robotic-assisted surgery for urologic procedures have brought about favorable outcomes that can influence both patient and surgeon success. Over the past years, there has been a dramatic transition in surgically managing a number of urologic conditions with the utilization of a robot-assisted surgical platform. As emphasized in current literature, performing surgery for prostate cancer has achieved the greatest attention and remarkable shift with which many of its cases are presently being carried out robotically. Owing to the technical refinements developed during the past years, enhanced outcomes have been achieved in terms of functional and oncologic results. With continual development of technological and surgical alterations, it can be expected that increased use of robot-assisted surgery will be applied for urologic conditions. It is similarly important to look into the outcomes of a robotic surgical platform in relation to their cost-effectiveness as developing countries are experiencing certain challenges in implementing robot-assisted procedures owing to increased costs, lack of access to technology, and even inadequate opportunities for educational and training opportunities to carry out such procedures. It can also be helpful to standardize the terminologies used to refer to robot-assisted surgeries to reduce possible inconsistencies and uncertainties in published literature. Nonetheless, the beneficial outcomes of robot-assisted surgery for patients and surgeons alike are of paramount relevance and should be further examined in future studies. References Castle, E.P., and Lee, D. (2008). Nomenclature of robotic procedures in urology. Journal of Endourology, 22 (7), 1467-1470. Patel, V. (2007). Robotic surgery: India is not ready yet. Indian Journal of Urology, 23 (3), 244-245. Raynor, M., and Pruthi, R. (2010). Robot-assisted surgery: applications in urology. Open Access Journal of Urology, 2, 85-89. Rogers, C.G., Sammon, J.D., Sukumar, S., Diaz, M., Peabody, J., and Menon, M. (2011). Rbot assisted radical prostatectomy for elderly patients with high risk prostate cancer. Urologic Oncology, in press. Tollefson, M.K., Frank, I., and Gettman, M.T. 2011). Robotic-assisted radical prostatectomy decreases the incidence and morbidity of surgical site infections. Urology, in press. Read More