Robot-assisted urological surgery in the Middle East: Where are we and how far can we go?

Raed A Azhar,Mohamed A Elkoushy,Saad Aldousari

doi:10.1080/2090598x.2019.1601003

Raed A Azhar, Mohamed A Elkoushy + Show 1 more

Open Access

https://doi.org/10.1080/2090598x.2019.1601003

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Abstract

ABSTRACTObjectives: To evaluate robot-assisted surgery (RAS) in Urology in the Middle East, and its status and future perspectives.Methods: A Medical Literature Analysis and Retrieval System Online (MEDLINE) search was performed using the following keywords: ‘robotics’, ‘robot-assisted surgery’, ‘laparoscopy’, at first with each specific procedure name, such as radical cystectomy, followed by ‘Middle East’ and country names. All abstracts and articles in English that adhered to the scope of the current issue were selected, giving special consideration to relevant landmark articles and those describing trends and the future of RAS in Urology.Results: Only a few index case reports characterised RAS in the Middle East. The Middle East possess only 1% of the da Vinci® Surgical Systems (Intuitive Surgical Inc., Sunnyvale, CA, USA) installed worldwide, including 19 in Saudi Arabia; six in Qatar; two in each of Kuwait and Lebanon; three in the United Arab Emirates; and only one in Egypt. The total number of RAS performed in the Middle East is low compared to Europe and the USA. Many countries in the Middle East still lack surgical robots despite having the expertise and appropriate caseload, whilst others seem not to utilise the surgical robot at a suitable rate, as reflected by the sparse number of operated cases and outgoing publications. There are major differences in RAS availability, usage, and perception according to the geographical place of practice and acceptance of robots by surgeons and patients.Conclusion: RAS in Urology continues to grow in the Middle East, with increasing caseloads and diversity of operated cases. Acceptance of robots by Middle East surgeons is significantly increasing.Abbreviations: 3D: three-dimensional; KSA: Kingdom Saudi Arabia;MIS: minimally invasive surgery; RAA: robot-assisted adrenalectomy; RAP: robot-assisted pyeloplasty; (O)(RA)PN: (open) (robot-assisted) partial nephrectomy; RAS: robot-assisted surgery; (O)(RA)RC: (open) (robot-assisted) radical cystectomy; (RA)RP: (robot-assisted) radical prostatectomy; SAUC: Sabah Al-Ahmad Urology Center

Highlights

Invasive surgery (MIS) has the advantages of improved perioperative outcomes, shorter recovery, reduced blood loss and perioperative complications compared to open surgery [1]
A few index case reports characterised the trends of Robot-assisted surgery (RAS) in the Middle East
A single article and a few case reports came from the Kingdom Saudi Arabia (KSA), one published article and two other abstracts came from Kuwait, three reports were published from Egypt, and a sparse data came from Lebanon, Qatar and the United Arab Emirates (UAE), which did not go beyond online commercial data or social media

Summary

Introduction

Invasive surgery (MIS) has the advantages of improved perioperative outcomes, shorter recovery, reduced blood loss and perioperative complications compared to open surgery [1]. Robot-assisted surgery (RAS), as an evolving worldwide MIS, has been successfully adopted rapidly over the last decade in Europe and USA in complex techniques, including oncological procedures involving the prostate, kidney and urinary bladder [2–4]. The emergence of robots, with three-dimensional (3D) magnified vision, EndoWrist® (Intuitive Surgical Inc., Sunnyvale, CA, USA) technology, depth perception, and precision with intuitive movement, has made intracorporeal dissection and suturing easier. Robotic surgical systems interpose a computer between the surgeon’s hands and the tips of extremely small devices, with designed programs helping to perform all complex procedures through tiny ports. Surgical robots enable less experienced surgeons to perform MIS using the robot after a relatively short learning curve [5,6]. Widespread acceptance of robotics may be influenced by the lack of tactile feedback, fixed-port system, longer operative times, and cost [7,8]

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