In Todays News: Robotic-assisted surgery speeds recovery from prostate removal

By Body and Mind staff
September 22, 2009, 12:00AM


Submitted photo: The da Vinci Surgical System uses a console with a magnified image of the operative field that allows doctors to see through small incisions in the skin.

Robotic-assisted surgery means fewer complications, a shorter hospital stay and quicker recovery for men with prostate cancer.

Using the da Vinci Surgical System, doctors can do a prostatectomy, or removal of a cancerous prostate gland, with greatly enhanced precision and a 3-D view of the patient's anatomy.

"The da Vinci allows us the ability to use articulation of the wrist, hands and fingers so that we're operating with the same finesse as with live, hands-on surgery but with a lot less blood loss," said Dr. R. Scott Owens, a urologist at Urology of Central Pennsylvania in Camp Hill. "The patient can go home in 24 to 48 hours and get back to normal activities in three to four weeks, rather than six to eight weeks."

A console that displays a magnified 3-D image of the operative field allows doctors to see depth and detail as they manipulate the instruments -- essentially a robotic hand and wrist -- through small incisions in the skin.

With colleague Dr. Christopher Moyer, Owens will be presenting "The Age of Robotic Surgery" on Sept. 28 at a prostate cancer awareness event at Holy Spirit Hospital.

For patients with localized prostate cancer, there are five options for treatment, Owens said. They are: surveillance, using the prostate-specific antigen (PSA) blood test; external radiation; insertion of radioactive seeds, or pellets, into the prostate; cryosurgery, which involves freezing the prostate to minus 40 degrees Celsius to kill normal and cancerous tissue; or radical prostatectomy.

Patients and their doctors decide on the best option depending on the patient's age, overall health status and grade or aggressiveness of the cancer, Owens said.

"Men who are good candidates for the da Vinci surgery are those under age 70 with localized prostate cancer and who have low, medium or high grade cancer," Owens said.

Incontinence and impotence are two complications of conventional open surgery that scare men away from it. With da Vinci, surgeons are beginning to see decreased incidence of those, making the decision to have surgery less intimidating, Owens said.

"If you're 50 and you have a higher grade cancer, you want that prostate out of there for a better chance of cure. With radiation, you never know, did it get all the cancer?" Owens said. "If you're 70, surgery has potentially higher risks and radiation is a safer alternative with less impact on quality of life."

Although both da Vinci and conventional laparoscopic surgery are minimally invasive because they use small incisions, da Vinci instruments allow doctors a much greater range of motion as they manipulate tissue.

Before da Vinci, most doctors were still doing open surgery involving large incisions because conventional laparoscopic surgery was so technically challenging, Owens said. Now, the da Vinci robotic surgery is used in about 70 percent to 80 percent of prostate cancer surgeries, he said.

In 2006, a Patriot-News report indicated da Vinci was used in about 25 percent of prostate removals nationwide.

Gynecologic and heart surgeries are also done using da Vinci, and it is likely to be used for many more types of surgery in the future, Owens said.

Holy Spirit Hospital, which purchased its da Vinci this summer, has the latest model with upgrades in technology and ergonomic improvements, he said.

Versions of the robotic surgical device, made by Intuitive Surgical, have been on the market since 1998. PinnacleHealth System acquired a da Vinci at Harrisburg Hospital in 2006 and has used it in prostate surgeries, according to The Patriot-News archives. Carlisle Regional Medical Center also offers surgery with the da Vinci.

Prostate cancer is the most common non-skin related cancer in American men and the second-leading cause of cancer death in men, according to the American Cancer Society.