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 endoscopy.
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.