Urology Patients Benefit from Robotic Technology

When David I. Lee, MD, joined Penn Medicine in 2005, he was one of the first urologists in the region performing robotic-assisted prostatectomy. Now, the procedure has become the standard of care — and the treatment of choice for most men.

Dr. Lee, chief of urology at Penn Presbyterian Medical Center, founded Penn’s robotic urology program. Five years later, he is one of the world’s most experienced urologists in the area of robotic-assisted prostatectomy, having performed more than 2,000 procedures.

The program at Penn has expanded with robotic-assisted procedures now performed at Penn Presbyterian, the Hospital of the University of Pennsylvania and Pennsylvania Hospital. And it’s not just for prostate surgery anymore. Penn urologists, members of the Urologic Cancer Program at the Abramson Cancer Center, are using robotic-assisted procedures to treat renal cancer, bladder cancer and using their minimally invasive skills in multidisciplinary programs with neurosurgery and women’s health.

Penn Presbyterian Medical Center


Robotic prostatectomy increases precision by allowing the surgeon a three-dimensional view of the prostate. The robot improves magnification of the prostate and surrounding area, allowing the surgeon to see small vessels and close them with sutures. As a result, the advantages over traditional prostate cancer surgery include:

• Less blood loss/fewer transfusions
• Less pain
• Less risk of infection
• Less scarring

Penn Presbyterian is a high-volume practice — Dr. Lee performs about 12 robotic-assisted prostate procedures a week — and the surgery takes about two hours. By comparison, surgeons less experienced in robotic procedures may take more than four hours to perform a robotic-assisted prostatectomy.
"We have found that having this extensive experience leads to improved continence and potency outcomes for our patients," Dr. Lee said.

In 2008, C. William Schwab, II, MD, began performing robotic partial nephrectomy at Penn Presbyterian as a treatment for kidney cancer. He is now also performing radical nephrectomy (complete removal of the kidney) and adrenalectomy (removal of the adrenal gland that sits above the kidney).

During the procedure, the kidney’s major blood vessels are clamped closed. Because so much blood passes through the kidney, the vessels cannot be closed for longer than 30 minutes without damaging the kidney tissues. During that 30 minutes, the surgeon must remove the tumor with a margin of healthy tissue and reconstruct the remaining healthy tissue.

"The robotic-assisted partial nephrectomy can be complicated, but is a good option for patients when their kidney tumors are amenable to a kidney sparing approach," Dr. Schwab said. "The procedure is now routinely performed and we continue to see positive outcomes with no tumor remaining after the surgery."

Penn urologists use robotic-assisted procedures to treat:

• Prostate cancer
• Renal cancer
• Bladder cancer and new multi-disciplinary programs with neurosurgery and women’s health.

Hospital of the University of Pennsylvania

Along with robotic-assisted prostatectomy and partial nephrectomy, urologists at the Hospital of the University of Pennsylvania are performing robotic-assisted cystectomy (removal of all or a portion of the bladder) and urinary diversion.

"Robotic-assisted cystectomy is typically a better approach for small bladder tumors," said Thomas J. Guzzo, MD, MPH. "Only a few hospitals are performing cystectomies robotically, but at Penn we continue to use the robotic surgical system more and use it for more complicated procedures."

Pennsylvania Hospital

At Pennsylvania Hospital, Daniel D. Eun, MD, performs robotic prostatectomy, partial nephrectomy and radical cystectomy. He is also taking robotic-assisted surgery to new levels, performing many new and cutting-edge urologic procedures with the surgical robot.

Dr. Eun is performing robotic-assisted retroperitoneal lymph node dissection, a procedure to remove abdominal lymph nodes to treat testicular cancer, as well as advanced kidney cancer. An aggressive form of renal cell carcinoma can be complicated by a tumor clot that invades into the large vessels and can eventually work its way into the right atrium of the heart.

Dr. Eun performed the first robotic-assisted surgical treatment for a renal cell carcinoma that had invaded into the vena cava, in which the kidney and the clot were removed and the vena cava reconstructed.

"This has never been described in the literature and as far as I know, it was the first robotic-assisted caval thrombectomy and reconstruction in the world," said Dr. Eun. "The patient went home 72 hours after surgery, as opposed to the 10 to 14 day hospital stay associated with an open procedure."

Dr. Eun is also lending his robotic experience to neurosurgery, providing minimally invasive spinal access for lumbo-sacral disc repair and spinal fusion.

Future Advances

Currently, Dr. Lee is collaborating with Katherine Kuchenbecker, PhD, from Penn’s innovation in mechanical engineering and applied mechanics program, to test an "add-on" for the surgical robot that enhances the surgeon’s sense of touch.

"One of the criticisms of the robot is the lack of tactile feedback provided to the surgeon," explains Dr. Lee. "With this add-on instrument, the surgeon receives a ‘vibration’ sense that may be very useful and make it easier to teach robotic surgical techniques."