Worth The Cost A Closer Look At The Da Vinci Robots Impact On Prostate Cancer Surgery
Urology fellow, Jeremy Fallot, and nurse, Shauna Harnedy, assist in robotic surgery by Ruban Thanigasalam in Sydney, Australia.Credit: Ken Leanfore for Nature
Loved by surgeons and patients alike for its ease of use and faster recovery times, the da Vinci surgical robot is less invasive than conventional procedures, and lacks the awkwardness of laparoscopic surgery. But the robots US$2-million price tag and negligible effect on cancer outcomes is sparking concern that its crowding out more affordable treatments.
There are more than 5,500 da Vinci robots globally, manufactured by California-based tech giant, Intuitive. The system is used in a range of surgical procedures, but its biggest impact has been in urology, where it has a market monopoly on robot-assisted radical prostatectomies , the removal of the prostate and surrounding tissues to treat localized cancer. Uptake in the United States, Europe, Australia, China and Japan for performing this procedure has been rapid. In 2003, less than 1% of surgeons in the US performed a RARP in preference to open or laparoscopic surgery. By 2014, RARP accounted for up to 90% of radical prostatectomies across the country. When it comes to prostate cancer surgery in the United States, says Benjamin Davies, surgeon and professor of urology at the University of Pittsburgh, the die is cast there is only robotic surgery.
What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible
There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.
For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.
These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.
Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.
The Steps Of The Robotic Prostatectomy
Robotic prostatectomy requires 5 small incisions, each about one-quarter of an inch in the lower abdomen, through which instruments are inserted. A sophisticated video camera is one of the instruments, which gives Dr. Samadi a three-dimensional, 10x magnified field of vision. The keyhole incisions drastically reduce blood loss and the camera provides unprecedented visual clarity. The result is a clear surgical field during the prostatectomy with nothing to obstruct Dr. Samadis view of the prostate and surrounding tissue.
Cameras are also used in laparoscopic prostatectomy, but they provide only a two-dimensional image and no magnification.
The prostate surgery follows these specific steps:
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Figure 2 Practice Makes Perfect
The likelihood that a surgeon performing laparoscopic prostatectomy will have to switch to open abdominal surgery in order to complete the operation goes down significantly with practice, measured in the number of operations performed.
Source: Journal of Urology, July 2005.
Did he mention anything about the visualization of the neurovascular bundles?
Yes, he felt pretty confident that with the increased magnification, he would be able to move them aside, and remove the prostate with no problem. He said, If the cancer has spread into the seminal vesicles, then obviously we have to deal with that. And we wont know until the operation. But he seemed pretty confident that after the operation Id be in good shape.
Did you consider having robotic surgery closer to home?
You know, I did look into it. But I did some research, and it looked like there werent many people doing this at the time in the city where I live, and they didnt have a lot of experience. One surgeon had done 50 of these operations. The doctor I met with had done about 400. So Im thinking, Okay, 50 versus 400. I think Ill go with the guy whos done 400.
What kind of logistics were necessary, with you being in one city and the operation being done in another?
There were some logistical challenges. I ended up doing the preoperative testing at a hospital near my home, and then had it sent to the surgeon in the other city. He was willing to accept their medical tests.
How long did you have it in place?
Disclosures And Important Safety Information
Risks associated with radical prostatectomy include leaking of urine, urgent need to urinate, cannot get or keep an erection, rectal or bowel injury, narrowing of the urethra, pooling of lymph fluid in the pelvic area or legs.
Important Safety Information
Patients should talk to their doctor to decide if da Vinci® Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options and associated risks in order to make an informed decision.
Serious complications may occur in any surgery, including da Vinci Surgery, up to and including death. Serious risks include, but are not limited to, injury to tissues and organs and conversion to other surgical techniques which could result in a longer operative time and/or increased complications. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.intuitive.com/safety.
Individuals’ outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience.
da Vinci Xi® System Precaution Statement
Medical Advice and Locating a Doctor
Surgeons experienced with the da Vinci System can be found using the Surgeon Locator. Intuitive Surgical provides surgeons training on the use of the da Vinci System but does not certify, credential or qualify the surgeons listed in the Surgeon Locator.
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How To Undergo Effective Treatment Abroad
If you are diagnosed with prostate cancer and you want to undergo effective and safe treatment, Turkey is ideal for your purposes. Luckily, in todays world, you can get treatment in almost any country. The number of patients electing for international treatment is growing rapidly every year. This can save you both time and money.
Surgery To Remove Your Prostate Gland
You might have surgery to remove your prostate gland if:
- your cancer hasn’t spread outside the prostate gland
- you are younger and have a fast growing tumour
- as part of treatment for locally advanced or high risk localised prostate cancer
The aim of a radical prostatectomy operation is to cure prostate cancer. It is major surgery with some possible side effects. If you’re an older man with a slow growing prostate cancer, this type of surgery may not be necessary for you. This is because your cancer might grow so slowly that you’re more likely to die of old age or other causes than from prostate cancer.
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Da Vinci Prostatectomy Procedure
During the da Vinci prostatectomy, which is done under general anesthesia, several small cuts are made in the skin of the lower belly. A small tube with a camera and surgical toolsheld by robotic armsare passed through these holes and guided to the location of the prostate. Once pinpointed, the gland is either partially or completely excised and removed through one of the incisions.
The surgeon uses a remote console the entire time to control the camera and the robot arms. Surgical tools can be swapped in and out on each arm. The da Vinci system also allows an assistant to help out with the surgery, as needed.
The entire procedure lasts around 3.5 hours, although more experienced surgeons may require less time. Once the prostatectomy is completed, the camera and the robot arms are withdrawn. The surgeon closes the abdominal muscles and the holes in the skin with sutures. Patients are usually discharged from the hospital 24 hours later.
Why A Prostatectomy May Be Recommended In Your Case
As you already know, a prostatectomy is recommended for the removal of prostate cancer. This surgical procedure is performed on patients whose cancer is confined to the prostate. The procedure involves the partial or total removal of the prostate gland, along with the seminal vesicles. The seminal vesicles connect to the vas deferens and secrete semen.
Besides prostate cancer, there may also be other reasons for a prostatectomy, such as prostate bleeding, slow urination, urinary retention, bladder stones, etc.
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Recovery Of Sexual Function After Robotic Prostatectomy
Following proper prostatectomy recovery guidelines, patients were able to achieve sexual function after prostate surgery.
Dr. Samadis unique nerve-sparing technique for prostate removal surgery is crucial to preserving sexual function. These tiny nerves surrounding the prostate course laterally along the prostate and rectum and provide nerve connections to the proximal penis deep in the pelvis. If they are damaged during prostatectomy, so is erectile function. Put simply, preserving the cavernous nerves preserves sexual potency after prostate surgery. There are treatments for erectile dysfunction resulting from prostatectomy surgery, but with the right surgeon and prostate surgery technique, they are often unnecessary.
More commonly, traditional prostatectomy inadvertently results in damage to one or both of the cavernous nerves.
What Are The Patient Criteria For Robotic
The decision to surgically treat prostate cancer involves many considerations. UC Davis urologic surgeons will discuss your treatment options and help you decide the best course of action. Nearly all patients diagnosed with localized prostate cancer will have the option of choosing robotic-assisted surgery. It is the now most commonly selected prostatectomy approach in the United States. Patients with significant abdominal adhesions or obesity, however, may not be appropriate candidates for the this procedure.
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Important Facts About The Da Vinci Prostatectomy
Although it has fastly evolved in the last few years, the da Vinci Surgical System is not a new procedure. It was introduced in 1999 by Intuitive Surgical.
- The first da Vinci prostatectomy in the world was performed in 2000, in Frankfurt, Germany.
- Nowadays, there are more than 1,700 da Vinci robots available in hospitals worldwide.
- There are more than 775,000 patients worldwide who have had a da Vinci procedure
- 3 out of 4 prostate cancer surgeries in the US are performed by means of the da Vinci robot
- Robotic prostatectomy performed with the help of the da Vinci machine has the lowest death rates, compared to radiation
- All top-ranked hospitals in the US have at least one da Vinci robot
There is no doubt we live in the era of robotic surgeries. It should not surprise us, considering all the great benefits of robotic prostate surgeries.
Back in 2002, Dr. David Samadi accomplished a robotic radical prostatectomy fellowship at Henri Mondor Hospital Creteil in Paris, France. Since then, Dr. Samadi has performed over 7,000 successful prostate surgeries using the da Vinci robot. What is more, Dr. Samadi has succeeded in modifying the procedure, creating a revolutionary approach, known as SMART Surgery.
The Da Vinci Robot Has A Motion Scaling Feature
Using the da Vinci System for robotic prostatectomy, the surgeon can use motion scaling, a feature that translates small hand movements outside the patients body into precise movements inside the body.
The surgeon controls the robotic prostate surgery robotic arms from the da Vinci console using natural hand and wrist movements. Motion scaling during robotic prostatectomy is designed to allow greater precision than is normally achievable in open and laparoscopic prostatectomy surgery. Indeed, conventional laparoscopic instruments provide surgeons less flexibility, dexterity, and range of motion.
Proprietary instruments called EndoWrist and enhanced range-of-motion of robotic arms enable surgeons to reach difficult places and to operate safely in the confined space of the closed chest, abdomen, or pelvis.
Laparoscopic instruments in use today do not replicate hand movements and cannot perform precise movement and manipulations needed for robotic prostate surgery, such as reaching behind tissues, suturing, and dissection. The system also filters out unpredictable movements and tremors inherent in human hands.
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Why Surgery With Da Vinci
A review of published studies suggest that potential benefits of a radical prostatectomy with da Vinci technology include:
- Patients may experience similar, or sometimes faster, return of erectile function than patients who had open.5-9
- Patients may experience similar, or sometimes faster, return of urinary continence than patients who had open within 6 months of surgery.5-9
- When compared to patients who had open surgery, patients undergoing surgery with da Vinci may have less chance of being readmitted to the hospital after leaving.9-12
- Patients may experience similar or fewer complications after surgery compared to patients who had open surgery.5-7,9-21
- Patients may stay in the hospital for a shorter amount of time than patients who had open surgery.5,6,8-11,13-16,18-27
What About Problems With Potency
Return of normal erectile function depends on a number of physical and psychological factors, including the type of prostatectomy . Function may return from one week to one year after surgery, It typically takes several months. A program of penile rehabilitation, using medications such as Viagra or Muse, is recommended as part of the process to facilitate healing and return of erectile function. Additional factors that can affect erectile function include hypertension, diabetes, obesity, atherosclerosis, smoking and anxiety.
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Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
Guided Da Vinci Robot Assists Prostatectomy Surgery At Weill Cornell
NEW YORK — At an international symposium June 25, Weill Cornell Medical College unveiled the latest star on its prostate cancer surgical team: a robot named da Vinci. The robot emulates the anatomic precision of its namesake to offer a new, minimally invasive and less compromising approach to prostatectomy, the removal of the prostate gland.
The symposium discussed advanced robotic techniques in prostatectomy. Ashutosh Tewari, assistant professor of urology and director of robotic prostatectomy and outcomes research, led the symposium, which featured a video demonstration of how the da Vinci can guide surgeons with anatomical precision to increase the success rate of the surgery, which is a treatment for localized prostate cancer.
The da Vinci robot assists surgeons in increasing the number of successful outcomes and in preserving neurovascular tissue. With the robot’s assistance, surgeons have achieved a delicate balance between these two goals. Critical pointers were provided at the symposium by those who have mastered robotic-assisted radical prostatectomy .
The symposium covered techniques of performing RRP, identifying suitable patients and understanding the latest developments in early sexual recovery following RRP.
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Equipment For Laparoscopic Radical Prostatectomy
The laparoscopic approach involves 2-dimensional monitors and conventional laparoscopic instruments with a 10-mm 0° and/or 30° telescope. The camera may be operated by a one-armed camera holder or by an assistant. The use of a single voice-operated robotic arm has also been described as an adjunct to the laparoscopic approach. A camera-holding device provides stability and prevents camera shake that can result from holding it by hand .
Smart Surgery Advanced Robotic Prostatectomy For Prostate Cancer
SMART Prostate Surgery
SMART is a revolutionary and advanced prostate cancer surgery and prostate cancer treatment method, which drastically reduces blood loss, pain, hospital stay, recovery time, and the side effects of other types of prostate cancer treatments. The SMART Technique is also known as bloodless prostate surgery. The SMART Technique does not require opening the endopelvic fascia or cutting the dorsal vein complex. This results in no sutures and less damage to the neurovascular bundle.
Dr. Samadi is able to enter into the patient through a few small keyhole entrances and handle the SMART robotic surgery with very tiny and precise instruments that allow him to perform the surgery with great precision and remove the patients prostate gland without doing any harm to surrounding tissue. The patient is left with only a few small marks on his abdomen none of the scars normally associated with prostate cancer treatment and surgery.
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Da Vinci Surgery For Prostate Cancer: What Is It Benefits Etc
The development of modern technology has allowed doctors to treat many diseases with minimal harm to your health. Thanks to the development of medical tourism, you can easily undergo minimally invasive treatment of cancer abroad.
One of the best countries in applying modern treatment methods is Turkey. Many hospitals in Turkey have robotic surgical systems, such as CyberKnife and Da Vinci. In Turkish clinics, da Vinci surgery for prostate cancer is especially popular due to its effectiveness and safety. A pleasant bonus of Turkey is its low prices for treatment with a high level of medical services.