Robotics in Indian Urology: Evolution, Clinical Applications and Future Direction| Chapter 6 | Newer Frontiers in Urology, Volume III

 

Laparoscopy, by the 1990s, had become standard for many urological procedures, but it had intrinsic limitations: two-dimensional vision, limited instrument articulation, tremor, and surgeon fatigue, especially in deep pelvic dissections. Robotic systems were developed to overcome these barriers, offering new levels of precision and control. Robotic systems combine the minimal invasiveness of laparoscopic surgery with enhanced dexterity, three-dimensional magnified vision, tremor filtering, and ergonomic advantages that preserve surgeon precision over long operations. In this chapter, the study expands our understanding of robotics in Indian urology by tracing its evolution and technological developments, examining its clinical applications in both oncology and reconstructive surgery, exploring its advantages and limitations, reviewing training and credentialing, and outlining recent advances and future directions. Robotic technology has permeated nearly every subspecialty of urology. Although its initial appeal was confined to oncological surgery—especially prostate and kidney cancer—its role now extends to reconstructive, functional, and even pediatric urology. The combination of tele-robotics and indigenous cost-effective systems could make complex urological surgery feasible even in government hospitals serving semi-urban populations. Robotic platforms now integrate indocyanine green (ICG) fluorescence imaging, which assists in vascular mapping during partial nephrectomy, delineating renal vasculature and collecting systems. Indian surgeons increasingly use real-time fluorescence to ensure complete tumour excision while minimising ischemia.

 

 

Author(s) Details

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-93-0/CH6

Innovations in Flexible Ureterorenoscopy for Renal Stones | Chapter 6 | Newer Frontiers in Urology, Volume II

 

Background: Flexible ureterorenoscopy (fURS) has become a cornerstone in the minimally invasive management of renal stone disease. Continuous technological evolution over the past decades has expanded its indications, improved procedural safety, and enhanced stone-free outcomes. This review synthesises recent innovations that have reshaped contemporary fURS practice.

 

Objective: To critically appraise key technological and procedural advances in flexible ureterorenoscopy, with emphasis on scope design, laser lithotripsy, adjunctive instrumentation, and emerging guidance and robotic systems, and to evaluate their clinical impact on renal stone management.

 

Methods: A narrative review was conducted based on historical milestones, recent clinical studies, systematic reviews, and meta-analyses addressing innovations in fURS. Developments in digital and single-use ureteroscopes, laser technologies, ureteral access sheaths, irrigation and pressure-control systems, image guidance, and robotic assistance were analysed with respect to efficacy, safety, and workflow implications.

 

Results: Major advancements include the transition to high-definition digital “chip-on-tip” ureteroscopes, the widespread adoption of single-use disposable scopes, and enhanced deflection mechanisms that improve access to complex calyceal anatomy. Laser innovations, particularly thulium fibre lasers and pulse-modulated holmium systems, have increased fragmentation efficiency while reducing retropulsion and operative time. Suction-enabled and pressure-controlled ureteral access sheaths have improved stone clearance and reduced infectious complications. Emerging technologies such as augmented reality navigation and robotic-assisted fURS have demonstrated stone-free rates comparable to those of conventional techniques while significantly improving surgeon ergonomics.

 

Conclusion: Technological innovation has transformed fURS into a highly effective, safe, and versatile modality for the treatment of renal stones. Ongoing integration of advanced lasers, innovative instrumentation, image guidance, and robotics is likely to refine outcomes further, personalise treatment strategies, and establish new benchmarks in endourological care.

 

 

Author(s) Details

Rajan Ravichandran

Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Roshan Reddy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Vivek Meyyappan
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Velmurugan Palaniyandi
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Hariharasudhan Sekar
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Sriram Krishnamoorthy
Department of Urology & Renal Transplantation, Sri Ramachandra Institute of Higher Education & Research, Chennai, India.

 

Please see the book here :- https://doi.org/10.9734/bpi/mono/978-93-47485-68-8/CH6