NEW YORKUrologic surgeons at Beth Israel Medical Center are turning for
help to a robot "assistant" that makes the difficult and time-consuming
procedure of laparoscopic radical prostatectomy easier and more efficient.
Compared to conventional open surgery, laparoscopic radical prostatectomy
is a minimally invasive procedure associated with a significant reduction in
blood loss and postoperative pain. However, the procedure, introduced only 4
years ago, has a steep learning curve and is difficult to master.
The da Vinci Surgical System, developed by Intuitive Surgical, Inc., of
Sunnyvale, California, promises to change all that. It combines a
high-resolution, three-dimensional imaging system with miniaturized,
robot-controlled instruments that can be moved precisely in any direction.
The combination permits delicate operations to be performed with far greater
dexterity and precision than would otherwise be attainable by conventional
At Beth Israel Medical Center, Caner Z. Dinlenc, MD, physician-in-charge
of endourology, and Joseph R. Wagner, MD, physician-in-charge of urologic
oncology, work as a team with two nurses and a surgical resident to perform
laparo-scopic radical prostatectomies using the da Vinci system. They have
completed 52 robot-aided operations to date. Beth Israel is one of only a
dozen hospitals in the United States where the procedure is now routinely
performed with robotic assistance.
Patients are typically discharged within 24 to 48 hours after the
procedure, require little or no pain medication, and can return to their
normal activities as early as 1 week after surgery, rather than the
traditional 6 to 8 weeks. And because the operation is minimally invasive and
precisely controlled, the risk of incontinence and impotencethe two major
complications of conventional radical prostatectomyis low.
"Every study done thus far, both European and American, has shown that
robotic surgery, at least in our early experience with the system, is as good
as open surgery," Dr. Dinlenc told ONI. "Most surgeons doing the
procedure feel confident that outcomes will continue to improve, ultimately
surpassing open surgical results."
The da Vinci Surgical System is a robotics-assisted apparatus for
performing endoscopic surgery under the direct control of a surgeon
experienced in laparos-copy. The operating surgeon sits at a console several
feet away from the operating table and manipulates the robot’s surgical
instruments remotely (see Figure 1). Another surgeon sits beside the patient,
maneuvering the placement of the robot’s arms and adjusting the camera and
instruments as needed.