Improved Results Posted for Found Robotic-Assisted Prostate Surgery

Doctor's Guide, October 12, 2004
By Mike Fillon

NEW ORLEANS, LA -- October 12, 2004 -- Men who undergo radical prostatectomy that involves use of a surgical robot have less blood loss during the procedure, shorter hospital stays, faster recoveries, and minimal use of narcotic medications during the recovery period with the same success rate as traditional surgery, according to results based on 300 patients.

Results of the study were presented here on October 11th at the American College of Surgeons 90th Annual Clinical Congress.

According to researcher, Vipul Patel MD, Director of Minimally Invasive Surgery, Urology Centers of Alabama, Birmingham, the average blood loss in the first 300 men who underwent robotic-assisted radical prostatectomy prostatectomy in the past 2 years was less than 50 mL, which is 300 to 2000 mL less than the typical amount of blood lost during standard open surgery.

Also, the men were hospitalized for 1 day after the operation compared with a 2- to 3-day hospital stay after conventional open surgery. Recovery time, assessed by validated quality of life questionnaires, and return to independent activity of daily living (IADL), was 7 to 10 days versus the 4 to 6 weeks for traditional open surgery.

Dr. Patel said the minimally invasive nature of the robotic surgery along with the postoperative use of anti-inflammatory agents and the subfascial infusion of anesthesia at home using the ON-Q Pain Management System (I-flow Corporation), permitted the researchers to achieve non-narcotic radical prostatectomy in 80% of patients. "Of that number, 20% do require narcotics, but the use is extremely limited," said Dr. Patel.

"It is extremely rare for a patient to have almost any type of surgery these days without the use of some form of narcotic agent," Dr. Patel said. "That's why it's amazing that patients are able to undergo major prostate cancer surgery without the use of any postoperative narcotics."

Traditionally, radical prostatectomy for prostate cancer requires a 15- to 20-cm incision in the lower abdomen and blunt dissection, meaning surgeons use their fingers to locate and manipulate the prostate gland before excising and removing cancerous tissue.

In the last few years, many surgeons have switched to the laparoscopic approach for protatectomy, which involves making a series of small incisions in the abdomen and introducing instruments that allow surgeons to see inside the abdominal area to dissect and remove prostate tissue. In this new approach, surgeons used a da Vinci Surgical System from Intuitive Surgical, which provides the surgeon with magnified view of the operative field and miniature articulating robotic instrumentation which translates the surgeon's hand, wrist and finger movements into real-time movements of the surgical instruments inside the patient.

"Using traditional laparoscopic instrumentation is challenging, it's like operating with chopsticks. The vision is 2-dimensional and the movements are counter-intuitive also," Dr. Patel explained. "There's articulation of the ends of surgical instruments. Whereas with the robot, you have a 'wrist' that can turn 360 degrees, which makes it easier to suture."

The robot improves magnification of the laparoscopic surgical field by a factor of 10 and provides 3-dimensional vision, which allows surgeons to see small vessels and close them with sutures. Consequently, there is reduced loss of blood and a 0-1% need for transfusions.

"Robotic prostatectomy makes a good surgeon even better because it enhances what you can do," Dr. Patel said. "It improves your ability to see the surgical field and allows increased surgical precision. This is important when attempting to remove the prostate while preserving the delicate nerves necessary for continence and potency… It definitely has the potential to become a standard of care in the future."

Robot-assisted radical prostatectomy is not yet widely available, with about 100 centers in the United States and Europe who offer robot-assisted prostate surgery. However, the da Vinci Surgical System is used frequently to perform heart surgery, remove gallbladders, treat gastroesophageal reflux disease, and perform gynecologic procedures, according to Dr. Patel. The surgical robot costs approximately $1.3 million.

Any comments on this article or you have any news: Click here

Disclaimer
NRIinternet.com will put up as many of your comments as possible but we cannot guarantee that all e-mails will be published. We reserve the right to edit comments that are published.