When is robotic kidney surgery recommended?
Robotic surgery for kidney and ureteric conditions has become an established and transformative approach in modern urology. Over the past decade, strong clinical evidence has demonstrated that robotic techniques can significantly improve patient outcomes, reduce complication rates, and shorten hospital stays when compared with traditional open or standard laparoscopic surgery. As a result, demand for robotic kidney and ureteric surgery has grown steadily worldwide.
My journey in robotic urological surgery
I began my robotic surgery career in 2017, at a time when robotic kidney surgery was gaining wider acceptance. Since then, I have witnessed—and contributed to—a substantial surge in the number and complexity of robotic procedures we perform.
Our early focus was robotic partial nephrectomy, a procedure that removes only the cancerous part of the kidney while preserving as much healthy tissue as possible. This approach is now considered the gold standard for suitable kidney tumours. As our experience expanded, we progressed to performing robotic radical (total) nephrectomy, particularly for more advanced cases such as stage III kidney cancer—operations that were traditionally managed with open surgery.
Over time, I transitioned completely from standard laparoscopy to robotic surgery. This decision was driven by clear and consistent benefits, including improved operative precision, shorter procedure times, lower complication rates, and the ability to safely manage more challenging and advanced cancers.
Robotic reconstructive and ureteric surgery
In addition to cancer surgery, robotic technology has allowed us to significantly expand our reconstructive work. We routinely perform robotic pyeloplasty for ureteropelvic junction obstruction, as well as complex ureteric procedures such as ureteric reimplantation and ureteric reconstruction.
As confidence and expertise grew, so did the volume of procedures. To date, I have performed in excess of 1000 robotic cases, making robotic surgery the mainstream approach for kidney and ureteric operations within my practice.
We have also engaged with the public and patient groups to increase awareness of robotic surgery through media coverage, public events, and publications in local outlets such as the Lancashire Post and BBC Northwest. This has led to wider acceptance of robotic surgery as a modern technique for kidney operations. https://www.lep.co.uk/health/prestons-robo-surgeon-hits-the-500-mark-in-two-years-667304
Robotic surgery for endometriosis-related ureteric disease
More recently, we have introduced robotic surgery for the management of endometriosis, particularly when it affects the urinary tract. This includes cases of ureteric obstruction and bladder involvement, where meticulous dissection and reconstruction are essential. The enhanced vision and dexterity provided by the robotic platform are especially valuable in these complex and delicate cases.
Teaching, mentorship, and proctorship
Alongside clinical practice, I am actively involved in teaching and mentoring surgeons in robotic urology. I have taught and mentored on multiple occasions and regularly act as a proctor for the da Vinci robotic system, supporting colleagues as they develop their own robotic programmes. Training and knowledge-sharing are essential to maintaining high standards and ensuring patient safety as robotic surgery continues to evolve.
Looking to the future
The future of robotic kidney and ureteric surgery lies not only in wider adoption but in continued technical refinement. One example is the use of intraoperative ultrasound for endophytic kidney tumours, a technique I regularly use to enhance tumour localisation and maximise kidney preservation.
Ongoing improvements in robotic equipment and technology are vital—not only to further improve patient outcomes, but also to support surgeon longevity by reducing physical strain and enhancing ergonomic efficiency.
This has been proved and studied in a recent article we published in the Annals Surgery Journal. 2023 Apr 28;4(2):e284.
Robotic surgery has now become central to the way we manage kidney and ureteric conditions. With continued innovation, training, and refinement, it will remain a cornerstone of high-quality urological care for years to come.
