Dr Mohan is a highly experienced Urologist, specializing in Uro-oncology, Andrology, Transplant, and Robotic Surgery. He has over 35 years of experience in this field. He has conducted more than 2500 laser fragmentation procedures for kidney and ureteral stones (RIRS and URS), over 3000 Laser Transurethral Prostate Procedures (LASER TURP), and performed 75 Pancreas transplants. He completed his MBBS from Bangalore Medical College and Research Institute, Bangalore and MS in General Surgery from Sheth K.M.School of PostGraduate Medicine and Research, Gujarat University, India. After this, he completed MCh from King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College. Dr. Keshavamurthy's areas of expertise include Kidney Transplantation, Laser Urology, complex Urinary Tract reconstruction, redo hypospadias surgery, penile lengthening surgeries, artificial sphincter insertion, and implantation of flexible and inflatable penile prosthesis.

The field of urology has witnessed a significant transformation with the advent of robot-assisted surgeries. This innovative technology has revolutionized how complex urological procedures are performed offering enhanced precision, reduced recovery times, and improved patient outcomes. As we embrace these advancements, it is crucial to ensure that patient safety remains at the forefront. This article delves into the protocols and best practices that healthcare institutions must adopt to ensure patient safety in robotic urology surgeries.

The Rise of Robot-Assisted Urological Surgeries
Robot-assisted surgeries, particularly using the da Vinci Surgical System, have become a cornerstone in urological care. These systems provide surgeons with enhanced dexterity, precision, and control through minimally invasive procedures. The robotic arms, equipped with miniaturized surgical instruments and a high-definition 3D camera, allow surgeons to perform intricate surgeries through small incisions, minimizing the risks associated with traditional open surgeries.

Ensuring Patient Safety: Protocols & Best Practices
1. Comprehensive Training & Certification
One of the cornerstones of ensuring patient safety in robot-assisted surgeries is comprehensive training and certification for surgeons. It is imperative that surgeons undergo extensive hands-on training, simulation exercises, and mentorship programs to master the use of robotic systems. Only those who have demonstrated proficiency should be certified to perform robotic-assisted procedures.
2. Preoperative Assessment & Patient Selection
A thorough preoperative assessment is critical to evaluate the patient's suitability for robot-assisted surgery. This includes a detailed medical history, diagnostic tests, and imaging studies. Patients should be informed about the procedure, potential risks, and expected outcomes to make well-informed decisions. Selecting appropriate candidates for robotic surgery ensures better outcomes and minimizes complications.
3. Enhanced Recovery after Surgery (ERAS)
Enhanced Recovery after Surgery (ERAS) is a comprehensive protocol aimed at
optimizing patient recovery post-surgery.

Robot-assisted surgeries, particularly using the da Vinci Surgical System, have become a cornerstone in urological care, as this system provide surgeons with enhanced dexterity, precision, and control through minimally invasive procedures

Key components of ERAS include:
•Carbohydrate Loading: Patients are given carbohydrate-rich drinks up until a few hours before the procedure. This helps maintain energy levels and reduce postoperative insulin resistance.
•Epidural Anaesthesia: This technique provides effective pain relief while minimizing the use of systemic analgesics, leading to quicker mobilization and recovery.
•Minimized Use of Analgesics: By reducing reliance on opioids and other strong painkillers, ERAS protocols decrease the risk of side effects and promote faster recovery.

One significant advantage of ERAS is its focus on early feeding. Patients can consume food shortly after the procedure, which accelerates gut recovery. This is crucial because the gut often becomes sluggish after abdominal surgeries due to the insufflation of carbon dioxide, delaying the overall recovery process. ERAS protocols address this issue by promoting early gut function, thereby reducing hospital stays and enhancing patient outcomes.

3. Advanced Technological Infrastructure
Investing in state-of-the-art robotic systems and ancillary technologies is essential for enhancing surgical precision and patient safety. Ancillary equipment such as an AC insufflator creates a dynamic environment to enhance surgical vision. This is crucial because the biggest drawback of robotic surgery is the lack of tactile feedback, leaving the surgeon to rely solely on visual cues.

In standard procedures, filling the abdomen with carbon dioxide provides a static volume. During bleeding, suction to control the blood also removes carbon dioxide, compromising vision. However, a dynamic insufflator like the ACL adjusts pressure to maintain a clear visual field, even during suction.
We are one of the few places in the country, who have utilized ACL insufflators from the beginning. These dynamic insufflators, developed through collaboration between the da Vinci and ACL companies, synchronize at the machine language level. This synchronization ensures the machines adjust automatically, maintaining optimal vision without manual intervention. This integration allows for continuous, clear vision, crucial for controlling bleeding and ensuring precision during surgery. These systems should provide real-time feedback, improved visualization, and the ability to perform complex maneuvers with utmost accuracy. Regular maintenance and updates of the robotic equipment are necessary to ensure optimal performance.

4. Intraoperative Monitoring & Anaesthesia
During robot-assisted surgeries, patients should be closely monitored using advanced anaesthesia and monitoring equipment. This allows for the prompt detection and management of any potential complications. Surgeons can make real-time adjustments based on the patient's condition, ensuring a safer surgical experience.

5. Multidisciplinary Collaboration
A multidisciplinary team approach is vital for the success of robotic-assisted urological surgeries. Surgeons, anaesthesiologists, nurses, and support staff must work in tandem to ensure seamless coordination throughout the surgical process. Effective communication and collaboration among team members contribute to better patient outcomes and safety.

6. Postoperative Care & Monitoring
Postoperative care is a crucial aspect of ensuring patient safety in robot-assisted surgeries. Patients should receive comprehensive postoperative care, including pain management, wound care, and regular follow-up visits. Dedicated nursing teams and rehabilitation programs should be in place to support patients during their recovery journey. Continuous monitoring and prompt intervention in case of complications are essential for a smooth recovery.

7. Patient Education & Engagement
Educating patients about the benefits, risks, and expectations of robot-assisted surgeries is essential for informed decision-making. Patients should be encouraged to actively participate in their care and follow postoperative instructions diligently. Engaged and well-informed patients are more likely to experience positive outcomes and satisfaction with their surgical experience.

Conclusion
Robot-assisted surgeries have revolutionized the field of urology, offering numerous benefits to patients, including minimally invasive procedures, faster recovery times, and improved outcomes. However, ensuring patient safety remains paramount. By adhering to comprehensive training programs, advanced technological infrastructure, meticulous preoperative and postoperative care, and a multidisciplinary team approach, healthcare institutions can provide the highest level of care to their patients. As we continue to embrace technological advancements in robot-assisted surgeries, patient safety must remain at the forefront of our efforts, ensuring a brighter and healthier future for all.