Tips and tricks in robotic urology: experience of Robotic Urology Center, Cluj-Napoca, Romania

Prof. Dr. Ioan Coman

Clinical Department of Urology, Cluj-Napoca Municipal Hospital, Romania Academic Vice-Rector of University of Medicine and Pharmacy “Iuliu Hatieganu” Cluj-Napoca Head of Urological Department of Municipal Clinical Hospital and Robotic Surgery Center Cluj-Napoca, Romania President of Romanian Urological Laparoscopic Association – Romanian Urology Association Member of European Urology Association Founding member of South East European Robotic Surgery Society (SEERSS) Co-Director of Robotic School of European Oncology Institute from Milan, Italy Distinguish Visiting Professor of University of Medicine and Pharmacy “N Testemitianu”, Chisinau, Moldova Republic

Nowadays, robotic surgery represents the most widely adopted type of minimally invasive surgery. But the advantages of this kind of approach are more than that: it allows excisions with the possibility of sparing noble anatomic structures (neuro-vascular bundles, urinary sphincter) or reconstructions with important functional outcomes (intracorporeal ileal neobladder, pyeloplasty).

The experience of the Robotic Urology Center in Cluj-Napoca comprises 300 procedures of all types of urologic surgeries for the upper and lower urinary tract: radical prostatectomy (190 cases), radical and partial nephrectomy (34 cases), adrenalectomy (26 cases), but also reconstruction surgeries like: pyeloplasty (32 cases), radical cystectomy with extra or intracorporeal neobladder (11 cases), vesico-vaginal fistula treatment (3 cases), retrocaval ureter (1 case) and nephropexy (3 cases).

The main concern when performing partial nephrectomy was the reduction of ischaemia time. In this context, we increased our interest in the surgical technique of zero ischaemia enucleation. We performed all the pyeloplasties exclusively by retroperitoneal approach with both types of urinary drainage: nephrostomy or ureteral stent.
Robotic radical prostatectomy is the main robotic intervention performed in our hospital. Having gained experience form it, we performed also robotic radical cystectomy with extracorporeal and intracorporeal orthotopic ileal neobladder. The preservation of the neuro-vascular bundles and of the anatomic structures with role in continence ensured the functional outcomes of radical cystectomy, and the use of mechanic suturing facilitated the intracorporeal digestive anastomosis.