The first urologic robotic program in the world was built at the Vattikuti Urology Institute, Henry Ford Hospital Detroit, Michigan, in 2000 under the vision of surgical innovator, Dr. Mani Menon for the radical prostatectomy. The robot-assisted radical prostatectomy continues being modified with techniques to improve perioperative and surgical outcomes. The application of robotic surgical technique has since been expanded to the bladder and upper urinary tract surgery. The evolution of surgical technique and its expansion of application will continue to improve quality, outcome parameters and experience for the patients.
The robotic approach in prostate surgery was introduced in originally in 2000 and at that time, only a few studies showed feasibility via a case report or series without clinical benefits. The robotic approach, known as The Vattikuti Institute Prostatectomy (VIP) has now been adopted exponentially since its introduction in 2000, when it was conceived at the Vattikuti Urology Institute (VUI) by Dr. Mani Menon.
Demonstrating a benefit in terms of perioperative outcomes reflected the initial experience with robotic prostatectomy at the VUI. Patients undergoing robot-assisted prostatectomy had shorter operating room times, lower estimated blood loss (EBL), lower complication rates, earlier urethral catheter removals, and a shorter hospital length of stay. Functional outcomes in terms of continence and potency were also improved. These benefits were attributed to the surgical robot's 3-dimensional vision, high quality and intuitive controls, and high degree of freedom in instrument movements. Although oncological outcomes and positive surgical margin (PSM) rates are equivalent between robot-assisted radical prostatectomy (RARP) and radical retropubic prostatectomy (RRP), RARP may have a benefit in a long-term cancer-recurrence free survival rate in D'Amico-classification high-risk prostate cancer patients. A systematic review by Ficarra et al. revealed that functional outcomes were favorable in RARP over RRP. Most of all, the enhanced visualization and dexterity of the surgical robot have helped to reduce postoperative complication rates, as demonstrated in a series of 3,317 patients by Agarwal et al. in 2011.
Guy Vallancien performed the first robot assisted radical prostatectomy using the da Vinci Surgical System. This technique called as the Montsouris technique became the “gold standard” for laproscopic prostectomy. The landmark study by Guillonneau and Vallancien demonstrates that the laparoscopic radical prostectomy could be done safely and effaciously within a resonable operative time. This study triggered the world wide interest in minimal invasive surgery.
The advent of surgical robotics allows practitioners of open surgery to perform laproscopic radical prostatectomy. Further studies by groups causes resurgance in the interest in minimally invasive surgical treatment of prostate cancer.
da Vinci robot gets FDA approval for abdominal surgery. Vallencien performs the first robot assisted prostectomy at VUI on Nov. 29th 2000.
Dr. Ralph Damiano, Jr., at the Milton S. Hershey Medical Center at Penn State College of Medicine in Hershey performed the first robotic assisted beating heart bypass in the United States using the Zeus Robotical Surgical System. (2014 photo)
Dr. Francois Laborde of L’Institut Mutualiste Montsouris Chiosy performed the first time pediatric cardiac procedures using Computer Motion’s Zeus robotic assistance to perform seven fully endoscopic closures of the patent ductus arteriosis (PDA).
Intuitive Surgical Inc. received clearance from the FDA to market the da Vinci Surgical System in the United States for use in laparoscopic surgical procedures.
The da Vinci robot surgical system received Food and Drug Administration (FDA) approval for abdominal surgery.
November 29, 2000 The da Vinci robot surgical system received Food and Drug Administration (FDA) approval for abdominal surgery. Vallancien and Menon perform the first robotic prostectomy on November 29, 2000 at the Vattikuti Urology Institute, Henry Ford Hospital in Detroit. The first patient, an autoworker from Detroit who was experienced in working with the first industrial robots and understood how precise they were. The first daVinci robot, “Leonardo” is leased and integrated in to the minimally invasive prostatectomy program at Detroit. At the same time, Abbou and collegues performed the first pure robot assisted radical prostatectomy. Small case series were then reported by Pasticier et.al and Rassweiler et. al.Vallancien and Menon perform the first robotic prostectomy on November 29, 2000 at the Vattikuti Urology Institute, Henry Ford Hospital in Detroit. The first patient, an autoworker from Detroit who was experienced in working with the first industrial robots and understood how precise they were.
SOCRATES™ Robotic Telecollaboration System was created by Computer Motion, Inc.. It includes integrated telecommunication equipment along with the robotic devices in order to provide remote surgical telecollaboration. This system was used for the first-ever transatlantic telesurgery performed.
FDA cleared the marketing of the CyberKnife with Dynamic Tracking Software (DTS) developed by Accuray Incorporated to provide radiosurgery for lesions, tumors, and conditions anywhere in the body when radiation treatment is indicated.
ZEUS® Robotic Surgical System from Computer Motion receives FDA regulatory clearance with the FDA decision for U.S. surgeons to assist in the control of blunt dissectors, retractors, graspers, and stabilizers a variety of instruments to perform a wide range of robotically assisted laparoscopic and thoracic procedures.
The CyberKnife® became the first image-guided robotic technology to receive FDA clearance for non-invasive cancer surgery to provide radio-surgery for lesions anywhere in the body when radiation treatment is indicated.
First daVinci, “Leonardo” installed at the Henry Ford Institute. The robotic system provides three-dimensional visualization, intuitive movement of instruments, and 360 maneuverability of the tips of the instruments through the laparoscopic ports. The systematic study of the robot assisted surgical techniques at VUI studies establishes that robot-assisted anatomic prostatectomy is a safe, effective and reproducible procedure for the management of clinically localized prostate cancer.
Prof. Marescaux used the Zeus robot to perform a cholecystectomy on a pig in Strasbourg, France while in New York.
ZEUS robotic system developed by Computer Motion was used in the trans-Atlantic operation. A doctor in New York removed the diseased gallbladder of a 68-year-old patient in Strasbourg, France.
The institute completed 115 open radical prostatectomy and 98 underwent either laparoscopic or robot assisted prostatectomy in the duration of one year.
Dr. Mani Menon and his team developed a procedure - the Vattikuti Institute Prostatectomy (VIP) using the da Vinci Surgical System. The procedure resembles open radical prostatectomy more than its laparoscopic variant, overwritten by technical nuances that are derived from robotic technology. By Nov 2002, > 300 Robotic Prostactomy and 270 VIP’s are performed. Patients undergoing robot-assisted prostatectomy had shorter operating room times, lower estimated blood loss (EBL), lower complication rates, earlier urethral catheter removals, and a shorter hospital length of stayaccording to published studies. Functional outcomes in terms of continence and potency were also improved. These benefits were attributed to the surgical robot's 3-dimensional vision, high quality and intuitive controls, and high degree of freedom in instrument movements.
Computer Motion merged with Intuitive Surgical, Inc., in June of 2003
Mani Menon and his team continue to finesse the VIP technique and report success in over 350 cases
VUI team completes the anatomical study with the help of an anatomist to unravel the course of neurovascular bundles in the male pelvis area, with the goal to develop a clear map to assist in the performance of nerve sparing laparoscopic or robotic radical prostatectomy with good anatomical landmarks adapted for the new surgical approach.
VUI team continues to prove VIP as a safe, effective and reproducible technique for removing the prostate. In most patients, it is done under 3 hours with minimal blood loss and a few complications. As the technique is refined, there has been a progressive decrease in operative time, blood loss, positive margins and complications.
Menon and team develop a laproscopic technique for nerve sparing RRCP (Robot assisted radical cystoprostatatectomy) using the daVinci system. The feasibiltiy study of a three step robot assisted, nerve-sparing radical cystoprostatectomy shows that the procedure combines the oncological concepts of open surgery with the technical nuances of robotic surgery.
July 2003 – Menon et al report first robot assisted radical cystectomy.
(Ref: J Am Coll Surg. 2004 Mar;198(3):386-93)
FDA cleared the marketing of a robotic-like system to assist in coronary artery by-pass surgery enabling the surgeon to perform heart surgery while seated at a console with a computer and video monitor.
The challenging techniques of Vasovasostomy and vasoepididymostomy procedures are performed with robot assistance with great success. The ultrafine setting of the robotic gear allows the surgeon to make large gross movement that are reduced to fine movements at the end of the robot arms - reducing the normal physiological tremor on part of the surgeon.
2 teams reported success in performing the difficult robotic procedures of RRCP, RRC and urinary diversions. (1, 2) Menon and team continue to apply the advantages of robotic assistance in advanced uro-oncological surgery, such as robot-assisted radical prostatectomy and robot-assisted radical cystoprostatectomy (RRCP) for patients who have muscle invasive bladder cancer.
VUI surgeons led by Menon have performed over 1100 cases of robotic radical prostatectomy. The team reduces the time to perform key steps (vesicourethral anastomosis) by over 50% in more than 90% of the patients and reduces the blood loss requiring no transfusion.
Introduction of robotic assisted laparoscopic urologic surgery emerges as a natural expansion of traditional laparoscopy, in which it offers the inherent advantages of minimally invasive surgery while improving the surgeons ability to perform technically challenging operations incases where traditional laparascopy is difficult.
Menon et.al., develop an original technique for performing robotic radical cystectomy (standard and uterus-preserving) in women using the da Vinci system and for constructing an ileal and orthotopic neobladder.
The team exceeds 1200 cases of robotic surgery various procedures have been performed, including anatomical radical prostatectomy for localized cancer of the prostat, retro pubic prostatectomy for benign hyperplasia of the prostate, radical cystectomy with urinary diversion for muscle-invasive cancer of the bladder in men and women, pylesplasty, adrenalectomy, nephrectomy, hysterectomy, myo mectomy, colpo suspension and vaso-vasal and vaso-epididymal anastomosis using the daVinci Robotic system
Surgeons at the Vattikuti Urology Institute pioneered a new technique of nerve-sparing robotic prostatectomy. The technique that preserves the prostatic fascia or the “Veil of Aphrodite” minimizes morbidity and maximizes functional outcomes. The technique is better than conventional nerve-sparing techniques in maintaing potency, and without compromising cancer control. The technique was possible due to the stereoscopic vision and magnification of the da Vinci robot, which permits accurate dissection of the fascial planes
The robotic surgery team from the Vattikuti Urology Institute travelled to the Institute of Urology and Nephrology, Kuala Lumpur Hospital (KLH) in Malaysia to perform Robotic renal surgery and extend the use of robots to perform trans-peritoneal stone surgery. The results of these 45 surgeries clearly showed that robotic extended pyelolithotomy (REP) is a safe and effective minimaly in vasive treatment alternative to PCNL (percutaneous nephrolithotomy) for some patients with staghorn calculi.
2200 VIP’s are performed by the VUI. By now VIP is used not only by the robotic surgeons but also by laproscopic prostatectomists. Several centers in US, Europe and Asia have utilized the technique or modifications of the technique.
2600 robotic radical prostatectomy procedures are performed by the VUI.
the ROBODOC® Surgical System received 510(k) clearance from the United States Food and Drug Administration (FDA) for Total Hip Arthroplasty procedures. This milestone marks the only active robotic system cleared by the U.S. FDA for orthopaedic surgery.
The VUI team describes a port placement technique for robtoic renal surgery that eliminates external collisions abd results in considerable flexibilty in the robotic arm movement. The technique involves the placement of the camera port laterally and robotic ports anteromedially allowed for enhanced reach of the robot into ureterovesial junction.
VUI team reports a safe, quick and reproducible technique of robotically assisted right adrenalectomy (RRA), leveraging a high definition, magnified three-dimensional view of the operating field provided by da Vinci robot
VUI team reports case series of pure robotic ureteroneocystotomy for repair of complex UVF (ureterovaginal fistula) using the daVinci system. The daVinci provides a tremendous advantage for gross identification of viable structures within the dense scar tissue and the identification of healthy ureter for reimplantation.
VUI team reports the initial experience with a novel robotic-assisted dissection of the infrarenal aorta and iliac arteries. This novel technique may overcome the difficulty of aortic dissection in a purely laproscopic aortic surgery and serves as a bridging step toward totally robotic assisted aortic surgery.
VUI surgeons report the first ever case of a robot assisted retro peritoneal cryoblation of a renal tumor
Surgeons at NIH report first successful robot assisted partial adrenalectomy with concurrent robot assisted extra-adrenal pheochromocytoma resection.
VUI surgeons participate in a multi institutional study to demonstrate the success of robotic partial nephrectomy for renal hilar tumors. Robotic assistance may facilitate tumor resection and renal reconstruction for challenging renal tumors, offering a minimally invasive and nephraon sparing surgical option for select patients who might otherwise require open surgery or total nephrectomy.
VUI surgeons in collaboration with the Cornell Institute of Robotic Surgery in New York, USA and the Institute of Urology at the University of Innsbruck in Austria report on the athermal trizonal nerve-sparing technique of robotic radical prostatectomy (RP). This technique is unique in several important ways. In particular it addresses concerns about the use of thermal energy and bulldog clamps during nerve sparing, it incorporates steps to preserve and handle the trizonal neural structures and it presents a simplified manoeuvre to identify the bladder neck.