Op-Ed: Robot-assisted Surgery – The Leading Treatment for Prostate Cancer

Op-Ed: Robot-assisted Surgery – The Leading Treatment for Prostate Cancer

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da Vinci

Prostate cancer surgeons around the world are using surgical robots to assist in the most delicate operative procedures. Across the country, nearly 1,000 of these robots have entered hospital operating rooms, including our institution: Swedish Medical Center in Seattle, Wash.

These minimally invasive devices, called daVinci surgical robots, offer patients substantially less pain, short recovery time and quicker return to normal activities than traditional open surgery. And because of this, the da Vinci and I have done more than 900 procedures together.

The da Vinci robot assists me during surgery by taking my movements and making them better: more precision, greater freedom of movement and no surgical tremor. These robots offer unmatched surgical precision – meaning my hand cannot compare to the dexterity of the robotic arms. We simply cannot turn our hands 540 degrees.  Da Vinci has 4 robotic arms, which I control at all times at the surgeon’s console. I look through a 3-D viewfinder at the console, which gives me visual depth, and a magnified view 10 to 15 times closer than human vision allows.  This magnified view gives me more precision as well.  Better visibility, better instrument movement means better surgery.

Through my years using da Vinci surgical technology, I know that it offers several advantages over conventional open surgery.  These include less pain, faster recovery, and less blood loss which means reduced need for blood transfusions. Because the surgery is performed through small incisions there is less internal scarring and less risk of bowel adhesions.

Most importantly, with regard to prostate surgery, using the robot has demonstrated improved outcomes over open prostatectomy.  In my experience this has resulted in less urinary incontinence, less erectile dysfunction, and excellent cancer control.

Coincidentally, I was diagnosed with prostate cancer in April 2006, and like all of my patients, the news was devastating. I looked at all the available treatment options and decided to pursue the robotic surgery over radiation therapy or open surgery.  For me, radiation was a shotgun approach and the nerves that control sexual function are potentially at risk from the radiation.  Having the prostate removed gave me information about the amount of cancer and whether it was contained inside the prostate.  This is important in predicting the future behavior of the cancer and I would not get this critical information if I radiated the prostate.

Another important factor in my decision is that once radiation is performed, and if the cancer were to come back, surgery is not an option after radiation due to the high complication rate and difficulty created by the effects of radiation on the tissues. Tissue just does not heal well after it has been radiated.  Conversely, if I had surgery first, and the cancer came back, then radiation was still an option. Essentially, I would be eliminating one treatment option if I had chosen radiation first.

Robot-assisted surgery allowed me to return to my normal activities quickly and this was important for my patients and practice. Through five small incisions about a half-inch in length, the robotic instruments and cameras are inserted into the patient (in this case, me). Compared to the open surgical incision, these incisions are significantly smaller and for many patients this alone is reason enough to consider the procedure over traditional open surgery. I was at home in just one day and at work within two weeks.

The typical prostate surgery patient after a more traditional operation is in the hospital two to three days and is recovering for four to six weeks.  Almost all my patients have gone home the day following surgery, and most are back to normal activities by two weeks.  90 percent of my patients don’t take narcotic pain medication once they leave the hospital.

Today, prostate cancer affects 1 in 6 men in America. A non-smoking man, for example, is more likely to develop prostate cancer than he is to develop colon, bladder, melanoma, lymphoma and kidney cancers combined.

Every man is at risk for prostate cancer. While the causes for prostate cancer are largely unknown, one thing is certain – the chance of developing prostate cancer increases in men over 50. While age is clearly associated, I am seeing more and more men with prostate cancer under the age of 50 and even under 40.  Close relatives of men with prostate cancer are also more likely to be affected.

This means that annually more than 192,000 men will be diagnosed with prostate cancer, and more than 27,000 men will die from the disease.  This ranks prostate cancer as the second leading cause of cancer death in men just behind lung cancer.

However, the future is no longer as bleak as it once was. If caught early, prostate cancer is a treatable disease, which many men have survived. Today about 85 percent of prostate cancer surgery is performed using the da Vinci robot – it has become the norm for the surgical removal of the prostate.

As a surgeon, I’m acutely aware that the location of the prostate gland deep inside the pelvis makes these surgeries a complex and delicate procedure. Removing the prostate is just part of the procedure.  Preserving the integrity of the tissues surrounding the prostate is essential to maintain urinary control and sexual function. That is why the benefits of robot-assisted surgery can be so critical.

Many men elect a robot-assisted prostatectomy because it often provides the fastest return to normal daily activities. My experience as both a surgeon and as a patient is proof. If you are diagnosed with prostate cancer, be sure to make an informed decision about your course of treatment by doing your homework and researching the best approaches available, including robot-assisted surgery.

Dr. James Porter is director of surgical robotics at Swedish Medical Center in Seattle, Wash. and a prostate cancer survivor. Under his leadership, Swedish is one of the first medical centers in the Pacific Northwest to perform robot-assisted surgery. Swedish’s robot-assisted surgical program was first established at Swedish in 2005. Since then, Swedish-affiliated surgeons have performed more than 2,000 procedures using the da Vinci Surgical System, more than any other robot-assisted surgical program in the Pacific Northwest. Dr. Porter is the first medical professional in the country to perform a retroperineral robot-assisted partial nephrectomy using the da Vinci robot (removal of a kidney tumor). Dr. Porter trains surgeons from around the globe how to use the da Vinci robot.

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7 Comments on "Op-Ed: Robot-assisted Surgery – The Leading Treatment for Prostate Cancer"


Guest
zach
Jan 29, 2010

Dr Porter is a paid consultant , a pimp , for intuitive surgical. He sees the world through the rose colored glasses of an investor in ISRG stock.
http://seattletimes.nwsource.com/html/health/2002611718_healthprostate09.html
“It feels like you’re able to move the instruments with more control,” says Porter, who is paid by Intuitive Surgical Inc. to instruct other surgeons in use of the da Vinci system.”
Dr. James Porter …as he remotely cut away tissue around the patient’s cancerous prostate.

Guest

As BrendaLee mentioned, I am not a medical professional either, but I am elated with the results achieved thru the DaVinci Robotic surgery received at Central Bucks Urology, http;//www.cburology.com, in Bucks County PA.

Guest
Nov 15, 2009

Having done extensive research on this topic, I do find robot assisted surgeries as very beneficial to the medical community.
http://www.roboticassistedsurgery.info/

Guest
BrendaLee
Nov 5, 2009

This new information is certainly going to confuse alot of people. This year, my husband had a radical prostatectomy via the DaVinci robot and the surgeon was recommended to us by another man who used this surgeon and swore by him. Neither this man or my husband (my husband is 58 and the other gent slightly younger)have experienced a second of incontinence. The erectile function is certainly diminished but not gone, but honestly if we had to pick, we would take the ED over a problem with incontinence any day of the week. What is our surgeon doing differently that gives him this stellar track record when everyone else who has been communicating with us from the blogs are having terrible problems with incontinence post DaVinci robot prostatectomies? I am not a medical professional, so there is nothing in it for me to ”push” any one method. I just am wondering about all of this at this point as I see talk recently about the hands-on method now being superior. Less than a year ago, all we heard was how the human touch (and eyesight) could not possibly compare with the DaVinci robot. No matter what the outcome of this latest controversy, I am thrilled we found the right surgeon with the right equipment.

Guest
bev M.D.
Oct 13, 2009

Oh, and see the article coming out in this week’s Journal of the American Medical Association (the journal is better than the AMA is) showing a higher incidence of erectile and urinary dysfunction in men having minimally invasive vs. open prostate cancer surgery…..I have not read it, but look forward to critically evaluating it.

Guest
bev M.D.
Oct 7, 2009

Wait – why is this not a commercial? Where is any other point of view, such as one from a radiation therapist?
Where are the medical references supporting the anecdotal assertion that use of the Da Vinci system results in improved outcomes?What is the physician’s and hospital’s fee for the Da Vinci procedure vs. standard radical prostatectomy? And, last, where is the disclosure regarding this physician’s relationship, if any, with the company manufacturing the device? Hello, editors?
On this same subject, see the recent post on Paul Levy’s blog (runningahospital.blogspot.com) regarding the multidisciplinary team in his hospital for prostate cancer patients, presenting all the various options in one visit. He also had a series of posts a year or so ago debating whether he should purchase the Da Vinci system for his hospital, finally crying “uncle.”
Disclosure: I am a pathologist so have been watching this unfold from the sidelines.