A surgical robot at the Rutgers New Jersey Medical School helped urologists complete “one of the longest single-port, retroperitoneal, buccal graft ureteroplasties on record,” said Evan Kovac, director of urologic oncology and robotic surgery at Rutgers New Jersey Medical School (NJMS) and University Hospital, in a statement.
Evan Kovac (left) and Amjad Alwaal (right). Images from Rutgers New Jersey Medical School
In 2011, the patient was treated for a gunshot wound to the abdomen at another hospital. Doctors inserted a stent into the patient’s ureter to repair damage from the bullet. These stents are typically used for three to six months, then removed. However, this stent was forgotten and became encrusted. Fixing this required invasive procedures, which caused a 10 cm long scar and severe narrowing of the ureter. The patient then required a tube in his back to drain his kidney, which was uncomfortable and carried the risk of infection.
Following that appraisal, Kovac and Amjad Alwaal, director of urologic reconstruction and men’s health, decided to aim to save the patient’s kidney with a robotic surgery.
The procedure requires one small incision on the patient’s navel or abdomen. This allows for faster recovery and less pain. The robot made an incision in the patient’s side “to stay away from the complex and scarred abdominal cavity,” Kovac said. All instruments for the surgery are able to enter through this small incision and then fan open.
The surgical team was able to reconstruct the patient’s ureter with mucosal tissue from the inside of his cheek. The surgery was completed in April 2024, and within months, the patient had 5% better kidney function.
“He was dealing with infections before, and also a nephrostomy tube, which pierced his back and drained urine into a bag wrapped around his thigh. These can become displaced and infected. They’re not comfortable and make it hard to sleep. His quality of life has drastically improved now,” Kovac said.
Robot-assisted surgery
Surgical robots typically have three main parts: robotic arms that hold the surgical instruments, an HD camera and a surgical console where the surgeon controls the robot, according to Cleveland Clinic.
Surgeons must complete additional specialized training to do robot-assisted procedures. Appendectomies, colectomies and gallbladder removals are some of the most common robot-assisted surgeries.
Instead of making one large incision, robot-assisted surgeries allow surgeons to make a few small incisions since these procedures require less space. Ports are placed through the incisions and act as temporary tunnels for the surgical instruments.
An endoscope camera is placed through one of the ports to provide HD, 3D images during the procedure. After the procedure is completed, the instruments, camera and ports are removed and the incisions are closed with sutures.
Robot-assisted surgeries offer less pain during recovery, lower risk of infection, reduced blood loss, shorter hospital stays and smaller scars than traditional surgeries.
Robotic surgery has an overall success rate of 94-100%, according to the Cleveland Clinic.
