Robotic surgery in urology

This matters most in three situations: when the work happens in a narrow, deep space (the pelvis), when precise suturing has to be done against the clock (the kidney), and when the urinary tract has to be reconstructed. In straightforward operations with a wide field, the advantage narrows.

Select the surgery you need

Choose the procedure and find out how the robotic approach may benefit you in your particular case. If you do not yet have a definitive diagnosis, choose the organ involved: we will determine the appropriate procedure during your consultation.

01Radical prostatectomyLocalized prostate cancer→ 02Partial nephrectomyKidney tumour · preserving the kidney→ 03Radical nephrectomyMore complex kidney tumour→ 04Radical cystectomyMuscle-invasive bladder cancer→ 05NephroureterectomyUpper urinary tract tumour→ 06Retroperitoneal lymph node dissectionTesticular cancer→ 07AdrenalectomyAdrenal gland tumour→ 08PyeloplastyUreteropelvic junction obstruction→

01 · Robot-assisted radical prostatectomy

For localized or locally advanced prostate cancer. It involves removing the entire prostate and the seminal vesicles, then reconnecting the bladder to the urethra. When the level of risk justifies it, an extended pelvic lymph node dissection is added.

What the robotic approach adds

• Less bleeding and a lower transfusion rate. This is the most consistent benefit across the literature.
• Shorter hospital stay and a faster return to normal activity.
• Finer dissection of the neurovascular bundles when the tumour allows them to be preserved, thanks to magnified vision in a very narrow space.
• Less postoperative pain and small incisions.

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02 · Robotic partial nephrectomy

For kidney tumours where it is possible to remove only the lesion and keep the rest of the kidney working. It is the standard for small masses and the goal whenever it is technically feasible.

What the robotic approach adds

• It preserves kidney function. Sparing the kidney is associated with a lower long-term risk of chronic kidney disease than removing it entirely.
• It makes kidney preservation possible in complex tumours —deep, near the hilum or the collecting system— which conventional laparoscopy would often force to be removed.
• Faster, more precise suturing, which shortens the time the kidney spends without blood flow.
• Particularly relevant in a solitary kidney, bilateral tumours or already impaired renal function.

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03 · Robotic radical nephrectomy

Complete removal of the kidney along with its surrounding fat, when the tumour is too large or so positioned that healthy tissue cannot be preserved.

What the robotic approach adds

• A real advantage in complex cases: bulky tumours, previous abdominal surgery, adhesions, or tumour extension into the renal vein.
• Safer vascular control during difficult dissections around major vessels.

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04 · Robotic radical cystectomy with urinary diversion

For bladder cancer that invades the muscle. It involves removing the bladder (together with the prostate and seminal vesicles in men, or the uterus and adnexa in women), performing a pelvic lymph node dissection, and reconstructing a new pathway for urine.

What the robotic approach adds

• Less bleeding and a lower transfusion rate, in one of the most demanding operations in urology.
• More days out of hospital in the first months, and fewer wound and thromboembolic complications.
• Intracorporeal reconstruction —ileal conduit or neobladder— without opening the abdomen.

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05 · Robotic radical nephroureterectomy

For urothelial tumours in the renal pelvis or the ureter. It requires removing the kidney, the entire ureter and a cuff of bladder around where the ureter enters it.

What the robotic approach adds

• A single surgical position to address two distant fields: the kidney above and the bladder below.
• A complete bladder cuff with a precise closure, a key step in reducing recurrence and one of the most technically demanding.
• It avoids a second incision in the lower abdomen.

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06 · Robotic retroperitoneal lymph node dissection

Removal of the retroperitoneal lymph nodes in testicular cancer, either as staging and treatment in early-stage disease, or to remove residual masses after chemotherapy.

What the robotic approach adds

• It avoids an incision running from the breastbone to the pubis, with a markedly shorter recovery in patients who are usually young.
• Preservation of the sympathetic nerves under magnified vision, which helps maintain antegrade ejaculation and, with it, fertility.

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07 · Robotic adrenalectomy

Removal of the adrenal gland for tumours that produce excess hormones or that are suspicious because of their size or imaging characteristics.

What the robotic approach adds

• Access to a deep gland surrounded by delicate structures, in a space where rigid instruments manoeuvre poorly.
• An advantage in patients with obesity and in larger tumours.
• It allows healthy cortex to be preserved in selected cases, avoiding lifelong steroid dependence.

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08 · Robotic pyeloplasty

Reconstruction of the junction between the renal pelvis and the ureter when it is obstructed, causing pain, repeated infections or progressive loss of kidney function. It is not a cancer operation, but it is one of the most rewarding.

What the robotic approach adds

• It is fine suturing surgery, precisely where articulated instruments make the greatest difference compared with laparoscopy.
• Success rates above 95%, equivalent to open surgery, with small incisions and a short stay.
• It preserves the kidney and halts the decline in its function.

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With the same honesty

Open, laparoscopic or robotic

All three routes arrive at the same place and pursue the same oncological result. What differs is how you get there, and in which operations that difference genuinely shows.

	Open surgery	Laparoscopy	Robotic
How the field is seen	Direct vision, in three dimensions	A flat screen, in two dimensions	Three dimensions with up to tenfold magnification
Instruments	The surgeon's hands	Rigid, with limited movement	Articulated, with full rotation and no tremor
Suturing in deep spaces	Difficult in a narrow pelvis	Very difficult	This is where it contributes most
Incision	One large one	Several small ones	Several small ones
Bleeding and transfusions	Greater	Lower	Lower
Hospital stay	Longer	Short	Short
Cancer control	It is the reference	Equivalent	Equivalent, not superior
Learning curve	Long	The longest of the three	Shorter than laparoscopy
Cost	The lowest	Intermediate	The highest
When it is still the best choice	Very large tumours, extensive adhesions, emergencies	Operations with no reconstruction or fine suturing	Reconstruction, suturing and dissection in narrow spaces

How to read this table

Look at the cancer control row: it says equivalent, not superior. That is deliberate. The randomised trials comparing the robotic route with open surgery —in prostate and in bladder— demonstrated non-inferiority. The robot does not cure better.

And look at the last row: there are operations where open surgery remains the correct choice. A very large kidney tumour, an abdomen full of adhesions from previous surgery, or a bleeding emergency are better dealt with by opening. Anyone who tells you everything is operated with a robot is describing their equipment, not your case.

Put as usefully as possible: robotics contributes where there is reconstruction to do —suturing a kidney, joining a urethra, building a new bladder. In operations that consist of removing and closing, the advantage narrows considerably. And above all of that weighs a factor no platform replaces: how many times a year your surgeon performs that particular operation.

What robotic surgery does not change

I would rather you arrived informed than convinced. These are the things technology does not solve, and that are worth knowing before you choose any surgeon.

• It does not operate on its own. The robot makes no decisions and performs no movements of its own. Every gesture is the surgeon's; the platform only transmits it with greater precision.
• It does not change the tumour's stage. An advanced cancer remains an advanced cancer. The surgical approach does not alter the biology of the disease.
• It does not replace a sound indication. The most important decision is whether to operate, when, and how extensively. That is settled with imaging and judgement, before entering the operating room.
• It does not make up for lack of experience. The factor that weighs most on your result is how many times the team operating on you has performed that specific procedure.

What backs the surgeon operating on you

To operate with a robotic platform, every surgeon must hold the manufacturer's certification (Intuitive Surgical, which makes the da Vinci system). It is an indispensable, non-negotiable requirement: it certifies that whoever is at the console knows how to handle the equipment. If a surgeon does not hold it, they should not be operating on you with a robot.

It is worth understanding what that certification does and does not certify. It is obtained through online modules, simulator and laboratory training, and an initial number of proctored cases. It validates the handling of the equipment. It does not assess surgical judgement, the depth of the technique, or the ability to resolve a complication with the patient already in surgery. In most hospitals, that certification is the only formal requirement demanded before starting to operate with a robot.

In my case, in addition to that certification, I completed a one-year international fellowship in robotic surgery at the Instituto Israelita Albert Einstein, in Brazil. A programme of that length adds things a course lasting a few days cannot cover:

• Written and practical examinations that must be passed. It is not a certificate of attendance: it is an accreditation with assessment involved.
• Formal teaching of the surgical technique, step by step and supervised, with enough case volume to consolidate it.
• Advanced management of complications specific to robotic surgery, trained before encountering them in a real patient.
• A protocol for equipment failure: what to do if the platform fails midway through an operation —emergency undocking, bleeding control and safe conversion.

That last point is the one almost nobody mentions and the one that weighs most on your safety. A robot is a machine and it can fail. The difference between a setback and a serious complication lies in whether the surgeon and the team trained for that scenario before it happened.

Related guides

If you arrived looking for information about your diagnosis, these guides explain the disease and all of its treatment options, not only the surgical one.