If your physician recommends the surgical excision of your tumor, it is possible that you may be offered the option of robotic surgery. This option is currently available for patients with prostate, bladder and kidney cancer.
Roswell Park Cancer Institute uses Intuitive Surgical’s da Vinci® Surgical System. This combines superior 3D visualization along with greatly enhanced dexterity, precision and control in an intuitive, ergonomic interface with breakthrough surgical capabilities.
The da Vinci® Surgical System is the first operative surgical robotic system approved by the FDA. It has been approved for use in performing many surgical procedures, including general laparoscopic surgery, thoracoscopic (chest) surgery, laparoscopic radical prostatectomies, and thoracoscopically-assisted heart procedures.
According to Intuitive Surgical, the da Vinci® Surgical System is currently being used in major medical centers around the world, including the United States, Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Sweden, Switzerland, and the United Kingdom.
To learn more about the da Vinci® surgical system, you can visit their website at www.davincisurgery.com or download this PDF brochure from their site (this link requires adobe acrobat).
Robotic Surgery Q&A
Q. What is robotic-assisted surgery?
A. Robotic-assisted surgery, a type of minimally invasive surgery (MIS), uses surgical robotic equipment which imitates movements initiated by the surgeon. MIS procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally advanced surgery with highly advanced clinical technology.
Q. What surgical procedures will the system be used for at Roswell Park?
A. Currently, the robotic-assisted surgical system is used for the removal of the prostate for cancer (radical prostatectomy). Over 700 prostate procedures have been completed. Additionally, over 100 patients with bladder cancer have been treated with this system. In the future, the system will be available to patients recommended for surgery for node dissection for testicular cancer. Additional future uses for the surgical system may include pediatric, gynecologic, thoracic, orthopedic, neurosurgery and gastrointestinal cancers.
Q. Is there a difference in patient outcomes when robotic-assisted surgery is compared with traditional surgery?
A. The success rate for the removal of cancer of the prostate is identical to "open" or traditional prostate cancer surgery. A patient’s recovery of urinary control is faster. Preservation of sexual function is at least as good as traditional surgery. In general, these are the advantages for this procedure:
- Less pain
- Less scarring
- Quicker recovery of urinary control
- Decreased blood loss and risk of infection
- Shorter hospital stay
- Faster recovery (many men can return to work in only 2 weeks)
Q. Has the surgical system been approved by the U.S. Food & Drug Administration (FDA)?
A. The da Vinci® Surgical System is the first operative surgical robotic system approved by the FDA. It has been approved for use in performing many surgical procedures, including general laparoscopic surgery, thoracoscopic (chest) surgery, laparoscopic radical prostatectomies, and thoracoscopically-assisted heart procedures.
Q. Where is the robotic-assisted surgical system being used now?
A. According to Intuitive Surgical, the da Vinci® Surgical System is currently being used in major medical centers in the United States, Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Sweden, Switzerland, the United Kingdom and around the world.
Q. What should I know about the robotic system?
A. The da Vinci prostatectomy uses a robotic surgical system that builds upon the laparoscopic approach and adds a few new benefits:
- The robot has four arms attached to a freestanding cart. One arm holds a camera (the laparoscope) and the surgeon operates the "hands" on the other three arms by inserting his or her fingers into rings and using foot controls.
- The arms have EndoWrists - flexible robotic wrists that bend and twist like human wrists.
- The surgeon uses hand movements and foot pedals to control the camera, adjust focus, and reposition the robotic arms.
- A robotic "arm" surgical system is used to control the endoscopic instruments instead of direct manipulation by the surgeon’s hands. These arms remain steady at all times and electronically dampen the "shake" of the human hand.
- Robotic surgical systems have a three-dimensional lens system, which also magnifies the surgical field up to 15 times. Surgeons have three-dimensional vision instead of the two-dimensional vision with regular laparoscopic procedures. Magnification improves the ability to recognize and control bleeding from small vessels and reduces blood loss.
- The visualization system requires the pressure in the abdominal cavity be increased. This has the added benefit of decreasing the amount of blood usually lost from blood oozing from the veins during surgery.
Q. How does the surgeon operate the system?
A. The surgeon sits at a console several feet away from the operating table while he or she is controlling the robotic system. The robotic wrists make it easier for surgeons to manipulate tissue and work from angles and positions that human surgeons would have difficulty achieving. This makes sewing the bladder to the urethra easier and more precise after prostate removal.
Q. Will robotic-assisted surgery eventually make surgeons obsolete?
A. Absolutely not. It will enable surgeons to be more precise, advancing their technique and enhancing their capability to perform complex minimally invasive surgery. The current generation of surgical robots cannot perform surgical tasks on their own, but they lend a mechanical "helping hand" to surgeons. The system replicates the surgeon’s movements in real time. It cannot be programmed, nor can it make decisions on its own to move in any way or perform any type of surgical maneuver without the surgeon’s input.
Q. How does the new technology assist the surgeon?
A. Surgeons are able to perform minimally invasive procedures with more precision. Robot arms remain steady at all times and electronically dampen the "shake" of the human hand. The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss. The U.S. Food and Drug Administration (FDA) requires that surgeons undergo special training before they perform robotic surgery on patients. Typical training requires 40 hours. The doctor’s first few robotic prostatectomies are mentored. Experienced prostate cancer surgeons are usually comfortable after approximately 3-10 cases. The nurses who work with the surgeons on the robotic procedure also receive special training.
Q. How is robotic-assisted radical prostatectomy different from open radical prostatectomy?
A. In contrast to open radical prostatectomy, the robot assisted procedure does not require a midline abdominal incision. This procedure uses tiny entry sites (ports) most of which are no longer than 10 millimeters (less than inch). Then the robot is docked, allowing the surgeon to view a powerfully magnified image in real time video. The surgeons utilize advanced technology of the robot's Endowrist (flexible wrists that bend and twist like human wrists) to remove the cancerous prostate gland.
Q. Does Roswell Park Cancer Institute offer robotic-assisted radical prostatectomy?
A. Yes, Roswell Park Cancer Institute has an established robotic surgery service. The da Vinci® surgical system is being used by our surgeons since August, 2004. Roswell Park has already performed over 600 robotic-assisted surgeries. Roswell Park has performed more than 500 robotic-assisted radical prostatectomies and over 100 robotic-assisted cystectomies (removal of the bladder).
Q. What are the benefits of robotic-assisted radical prostatectomy?
A. Several advantages are seen after the procedure:
- Unparalleled surgical accuracy
- Easy manipulation of instruments in a narrow space (the human pelvis) allows the surgeon to perform a gentle operation
- Significantly less pain
- Minimal blood loss
- Less hospitalization
- Earlier Foley catheter removal
- Quicker recovery time
Q. How experienced is the team at Roswell Park Cancer Institute performing the robotic-assisted radical prostatectomy procedure?
A. Roswell Park initiated its program in 2004. Our team has already performed over 600 robotic-assisted surgeries. The urologic oncology team at Roswell Park has performed more than 500 robotic-assisted radical prostatectomies.
Q. Who constitutes the Roswell Park robotic urology team?
A. The team is comprised of five urologic oncology surgeons with robotic surgery and laparoscopic surgery fellowship training. The nursing staff is made up of a team of dedicated minimally invasive laparoscopic and robotic nurses.
Q. Which patient is an ideal candidate for robotic-assisted radical prostatectomy procedure?
A. Any patient with the diagnosis of localized prostate cancer and good general health can be evaluated for the procedure. The ideal procedure is to complete our consultation form or schedule an appointment.
Q. What are the risks of robotic-assisted radical prostatectomy procedure?
A. Robotic-assisted radical prostatectomy is a major cancer operation performed using full general anesthesia like any other major operation. The risks include infection, bleeding, injury to bowel, vessels, rectal injury, risk of erectile dysfunction and urinary incontinence. The risks associated with any major operation like cardiac event, deep venous thrombosis, stroke, and death are a possibility.
Q. How long will my hospital stay take?
A. An average patient goes home the day after the operation, or can stay an extra day depending upon his recovery. All of our robotic prostatectomy patients have gone home the day after surgery.
Q. When does the Foley catheter come out?
A. We usually remove the catheter in seven to ten days, at the first postoperative clinic visit.
To learn more about the da Vinci® surgical system, you can visit their website at www.davincisurgery.com or download this PDF brochure. from their site (this link requires adobe acrobat):
The Robotics Difference
In contrast to open radical prostatectomy, the robotic-assisted procedure does not require a midline abdominal incision. This procedure uses tiny entry sites (ports) most of which are no longer than 10 millimeters (under 1/2 inch). Then the robot is docked, allowing the surgeon to view a powerfully magnified image in real time video [insert link to video]. The surgeons utilize advanced technology of the robot's EndoWrists (flexible wrists that bend and twist like human wrists) to remove the cancerous prostate gland.
The Roswell Difference
Roswell Park Cancer Institute has an established robotic surgery service. Our surgeons have used the da Vinci® surgical system since August 2004. Roswell Park has already performed more than 600 robotic-assisted surgeries including more than 500 robotic-assisted radical prostatectomies and over 100 robotic-assisted cystectomies (removal of the bladder).
The robotics team is comprised of five urologic oncology surgeons with robotic surgery and laparoscopic surgery fellowship training. The nursing staff is made up of a team of dedicated minimally invasive laparoscopic and robotic nurses.
Robotics Offers More Benefits for Prostate Cancer Patients
Several advantages are seen after the procedure:
- Unparalleled surgical accuracy
- Easy manipulation of instruments in a narrow space (the human pelvis) allows the surgeon to perform a gentle operation
- Significantly less pain
- Minimal blood loss
- Less hospitalization
- Earlier Foley catheter removal
- Quicker recovery time
Unlike "open" prostatectomy, patients are usually able to go home the day after robotic-assisted prostatectomy. Patients generally experience less post-operative pain and discomfort and have a faster recovery. Many men are able to return to work as soon as two weeks after surgery. Any patient with the diagnosis of localized prostate cancer and good general health can be evaluated for the procedure. Schedule an appointment for an evaluation at Roswell Park.
