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Student Education

Robotics in urology

BMJ 2007; 335 doi: (Published 01 October 2007) Cite this as: BMJ 2007;335:0710374
  1. Kerry Davies, third year medical student1,
  2. Declan Murphy, specialist registrar in laparoscopic and robotic urology2
  1. 1Guy's, King's, and St Thomas's School of Medicine, London
  2. 2Guy's Hospital, London

Innovation in robotics is gradually transforming surgery. Kerry Davies and Declan Murphy discuss the implications for urology

Urological surgery has become increasingly complex, and as a result it has moved away from general surgery and has been a specialty in its own right for more than 20 years. Subspecialisation, however, is new, and minimally invasive or laparoscopic surgery and robotic surgery is one such division. The opportunities to work in units focused on research or to become involved in cutting edge technology make it an exciting and popular career choice for many surgical trainees.

Previously, urologists initially trained in traditional open surgery techniques, however, open surgery is associated with increased recovery time and blood loss and is generally less acceptable to the patient. For these reasons techniques in minimally invasive surgery have largely replaced open procedures, and now many urologists train primarily in endoscopic and laparoscopic techniques. The treatment of urological problems has evolved from invasive open surgical techniques to the more familiar endoscopic procedures, such as for stone removal, associated with modern urology.

Laparoscopic surgery

Laparoscopic surgery is different from endoscopic surgery and represents a completely new experience for surgeons who must learn a new view of surgical anatomy, new operative procedures, and new surgical tools. Laparoscopic surgery is challenging because of decreased range of motion, limited degrees of freedom, lack of depth perception, and counterintuitive motion. Laparoscopic urologists have to overcome the difficulties presented by two dimensional imaging.1 Absence of shadows, stereovision, and movement in parallax makes determining spatial distance difficult and impairs hand-eye coordination. Carbon dioxide is insufflated into the working cavity, creating a pneumoperitoneum, causing a tamponade effect (the positive pressure of carbon dioxide results in venous compression).

The rise of surgical robots

Surgical robots are not fully automated robots in the true sense but are in fact “master-slave” systems that allow …

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