A model of implementing robotic surgery in the urological field. An inside view from the Robotic Urologic Surgery Center of Cluj-Napoca

Ioan Coman*, Nicolae Crișan*, Ottavio de Cobelli**, Deliu Victor Matei**

* SCM Cluj-Napoca, **IEO Milano

Robotic surgery can be considered a standard for some urological surgeries. The main objective of this paper is to evaluate the efficiency and specifics of implementing robotic surgery in a center with expertise in standard laparoscopy.

Material and method:
Implementing robotic assisted surgery in the urological field supposes crossing five main steps: gathering a team focused on mini invasive surgery, establishing a collaboration with a center of excellence in robotics for trainings, performing robotic surgeries under the close guidance of the trainig team, shortening the learning curve by perfoming surgeries assisted by a preceptorship and expanding robotic indications through most urological procedures accomplished.

After implementing robotic surgery that followed standard laparoscopic urologic surgery, in a short period of time, from november 2009 until march 2012, our team performed 152 robotic urologic surgeries, approaching all surgeries in the urologic pathology. There have been performed excision surgeries like: radical prostatectomy (72 cases), radical and partial nephrectomy (24 cases), suprarenalectomy (21 cases) but also reconstruction surgeries like: pyeloplasty (21 cases), radical cystectomy with extra and intracorporeal neobladder (8 cases), vesico-vaginal fistula treatment (2 cases), retrocaval ureter (1 case) and nephropexy (3 cases).

Robotic surgery represents an approach method that can be quickly taught to experienced laparoscopic centers and allows performing most urological surgical techinques, but also implyes a dedicated team, concern for mini invasive surgery, willingness to overcome learning difficulties and nevertheless significant financial resources.