Robotic surgery is an innovation that has revolutionized modern medicine, particularly in urology. Introduced in the late 1990s, robotic technology was designed to overcome the limitations of traditional surgical techniques. The first widely recognized system, the Da Vinci Surgical System, was approved by the FDA (Food and Drug Administration) in 2000. Since then, it has been continuously improved, becoming an indispensable tool in minimally invasive procedures.

Robotic technology has evolved significantly since its introduction. Modern systems have articulated arms, high-definition 3D cameras, and instruments with movements that mimic and even surpass human dexterity. In urology, these features are especially useful, as the organs involved are located in anatomically difficult-to-access areas.

Procedures such as nephrectomies (partial or total removal of the kidney), pyeloplasties (repair of the ureteropelvic junction), and cystectomies (removal of the bladder) also benefit greatly from robotic technology. Additionally, robotics is frequently used in interventions to correct benign conditions, such as benign prostatic hyperplasia (BPH) and kidney stones.

With continuous advancements, new robotic platforms and more accessible systems are being developed, expanding the availability of robotic surgery in different regions of the world.

Robotic surgery offers numerous benefits, both for the patient and the surgeon. Among the main advantages are:

1. Surgical Precision: The robotic system allows for more precise and stable movements, reducing the risk of damage to surrounding tissues and increasing the effectiveness of the procedure.

2. Less Trauma to the Patient: Being minimally invasive, robotic surgery requires small incisions, resulting in less postoperative pain, less bleeding, and a lower risk of infection.

3. Faster Recovery: Patients undergoing robotic surgery usually have shorter hospital stays and return to daily activities more quickly.

4. Better Functional Outcomes: In urology, preserving sexual and urinary function is a crucial goal. The precision of robotic technology significantly contributes to better outcomes in these aspects, especially in procedures such as radical prostatectomy.

5. Comfort and Ergonomics for the Surgeon: The robotic platform offers doctors a more comfortable working position, reducing fatigue and allowing greater focus during long surgeries.

6. Advanced Visualization: High-definition cameras and three-dimensional vision provide the surgeon with an enlarged and detailed view of the operated area, facilitating the identification of delicate structures.

Robotic surgery continues to redefine the standards of urological medicine. With the arrival of more accessible systems and the integration of artificial intelligence, robotics is expected to become even more precise and personalized. Additionally, training on virtual simulators is democratizing access to training in this technology, allowing more professionals to gain experience in robotic procedures.

In summary, robotic surgery represents a milestone in the history of urology. Its combination of cutting-edge technology and clinical benefits positions it as one of the most important tools in the pursuit of more effective, safe, and humane treatments.

Whether for treating benign or malignant conditions, robotic surgery is a shining example of how innovation can transform lives and elevate the standards of medical care.

Professor Tiago Rosito was the first surgeon in Latin America to perform vaginoplasties using the peritoneal technique with the assistance of the robotic platform. This revolutionary approach is used for:

• Transgender female patients (MTF): The peritoneal technique offers a modern solution for vaginal enlargement, using peritoneal tissue to create a vaginal canal with natural lubrication and greater comfort, meeting the functional and aesthetic expectations of patients.

• Women with vaginal agenesis: For women born without a vaginal canal, such as in cases of Rokitansky Syndrome, the robotic peritoneal technique is a minimally invasive option that provides lasting results with less postoperative impact.

• Women undergoing cancer treatments: Patients who have had their vaginal canal compromised by cancer treatments, such as pelvic radiotherapy, find in the peritoneal technique an effective alternative for vaginal reconstruction with fewer risks of complications.

The use of the robotic platform in this technique is innovative and brings significant benefits, such as greater precision in dissection and suturing, less surgical trauma, and better functional and aesthetic results.

In addition to his work with gender affirmation surgeries, Professor Tiago Rosito is also a pioneer in Brazil in the use of robotic surgery for complex reconstructive procedures in children and adults. He has applied the robotic platform in a wide range of surgeries, including:

• Pyeloplasties: Correction of stenoses in the ureteropelvic junction, restoring urinary flow with high precision and excellent success rates.

• Ureteroplasties: Reconstruction of ureteral segments damaged by obstructions, injuries, or previous treatments, reducing the risk of recurrence.

• Bladder augmentations and catheterizable conduits (Mitrofanoff): For patients with conditions that compromise bladder capacity or functionality, especially in children with congenital problems or sequelae from previous surgeries.

• Pediatric reconstructions: Robotics applied to pediatric urology enables less invasive interventions with better outcomes in children requiring complex corrections.

The work of Professor Tiago Rosito has placed Brazil at the forefront of robotic surgery in urology, attracting international recognition for the quality of the procedures performed and the clinical results obtained. His dedication to research and medical practice has also inspired the training of new generations of surgeons, promoting the use of robotics in challenging cases that previously relied exclusively on open or traditional laparoscopic techniques.

With his innovative vision and commitment to excellence, Professor Tiago Rosito not only redefines the limits of reconstructive and gender affirmation surgery but also contributes to the democratization and refinement of the use of robotic technology in medical procedures. His leadership in the field is a milestone for Latin American medicine and an example of how innovation can transform lives, providing dignity and quality of life to his patients.

The pioneering work of Professor Tiago Rosito highlights robotic surgery as a revolutionary tool, both for functional procedures and for interventions that profoundly impact the identity and well-being of patients, consolidating Brazil as a reference in this field of medicine.

The robotic platform offers unparalleled precision thanks to its articulated instruments, which allow for millimeter and subtle movements, as well as high-definition three-dimensional vision. This precision is crucial in reconstructive surgeries, where the goal is to preserve delicate structures and restore the functionality of the urinary and genital tract.

• Pyeloplasties and Correction of Ureteropelvic Junction Stenosis: Robotics is particularly advantageous in surgeries to treat obstructions at the junction between the ureter and the renal pelvis. This technology facilitates the precise removal of the obstructed segment and the performance of perfect anastomoses (reconnections) between the ureter and the renal pelvis, ensuring adequate urinary flow and reducing the risk of stenosis recurrence.

• Ureteroplasties: Robotics facilitates the reconstruction or replacement of ureteral segments with greater precision, reducing the risk of stenosis or urinary leaks.

• Bladder Augmentations: In surgeries to increase bladder capacity, enhanced vision and robotic control allow for safer sutures and perfect tissue integration, essential for ensuring long-term functional success.

• Catheterizable Conduits (Mitrofanoff): The precision of robotics allows for the creation of conduits that connect the bladder to the exterior, usually using the appendix or other intestinal segments. This is crucial for patients who require intermittent catheterization, ensuring a functional connection, with good continence rates and fewer complications such as stenosis or leaks.

The minimally invasive approach provided by robotics reduces trauma to the surrounding tissue, a significant advantage in complex and lengthy surgeries. With smaller incisions and greater stability of the instruments, the impact on the patient's body is minimized, resulting in:

• Less pain in the postoperative period.
• Lower risk of infection.
• Reduction of visible scars, a relevant aspect in surgeries such as gender reassignment.

Robotic technology allows for a faster recovery compared to open or traditional laparoscopic surgeries. This is especially important in reconstructive procedures, where the goal is not only to correct anomalies but also to restore the patient's quality of life.

• Pyeloplasties: Patients undergoing robotic correction of ureteropelvic junction stenosis experience a significant reduction in symptoms (such as lumbar pain and recurrent infections), with shorter hospital stays and faster recovery of renal function.

• Gender Reassignment: Robotics enables greater precision in the reconstruction of genital organs, preserving sensitivity and functionality.

• Bladder Augmentations: Less surgical trauma and the use of robotic techniques ensure that patients return to their daily activities more quickly, with a significant improvement in urinary function.

• Catheterizable Conduits: Patients who receive Mitrofanoff conduits can perform catheterization more efficiently and discreetly, promoting independence and a significant improvement in quality of life.

Robotics allows surgeons to perform intricate sutures and detailed reconstructions with high precision, essential for preserving urinary and sexual function. Additionally, the use of small portals and the precision of cuts minimize external and internal scars, providing better aesthetic and functional results.

• Pyeloplasties and Ureteropelvic Junction Stenosis: Robotic precision significantly reduces the risk of complications such as urinary leaks or the formation of new obstructions, ensuring effective restoration of urinary flow and preservation of renal function.

• Ureteroplasties: The ability to perform precise anastomoses between ureteral segments or between the ureter and the bladder improves long-term success rates.

• Catheterizable Conduits: The creation of the Mitrofanoff with robotic assistance results in well-positioned and functional conduits, reducing complications and promoting a discreet aesthetic.

• Gender Reassignment: Robotic surgery enables more precise modeling of genital organs, preserving blood vessels and nerves crucial for sensitivity and functionality.

In addition to the benefits for the patient, the robotic platform offers greater comfort to the surgeon, who works in an ergonomic position with full control of the instruments. This reduces fatigue in long procedures, such as those frequently observed in reconstructive surgeries.

The stability of the robotic system and the magnification of vision significantly reduce the risk of intraoperative complications, such as hemorrhages, damage to adjacent structures, and infections. Additionally, precise control allows for minimizing surgical time in many cases.

The use of the robotic platform in reconstructive urological surgeries represents a significant advancement in medicine. Whether in pyeloplasties, corrections of ureteropelvic junction stenosis, ureteroplasties, bladder augmentations, creation of catheterizable conduits (such as Mitrofanoff), or gender reassignment surgeries, robotic technology offers unique benefits that improve functional, aesthetic outcomes, and the quality of life of patients. Combining surgical precision, less trauma, and accelerated recovery, robotic surgery establishes a new standard of excellence in reconstructive urological treatment.