The Urology section is devoted to helping our patients make a full recovery and return to the quality of life they once knew. We’ve developed a dedicated operating suite for robotic surgery, a state-of-the-art extension to the operating suites specifically designed for minimally invasive surgery.
Using the latest generation da Vinci® Surgical System, we offer robotic procedures for prostatectomy, partial nephrectomy and tk. Our pediatric urologist employs robotic technology for delicate reconstructive surgeries on small children.
Robotic Prostatectomy
Approximately 16% of American men will be diagnosed with prostate cancer sometime
in their lives. Treatment options and prognosis depend on the stage of the cancer,
the Gleason score, and the patient’s age and general health.
With greater public awareness, early detection is on the rise and mortality rates are declining. Additionally, new advances in medical technology are enabling cancer patients to go on to live active and productive lives after treatment.
For localized prostate cancer, radical prostatectomy (surgical removal of the prostate and surrounding cancerous tissues) has historically been considered the “gold standard,” or definitive way to remove the cancer.
Removal of the prostate gland with the robotic surgical system is an effective, minimally
invasive approach to surgical treatment of prostate cancer. This method incorporates
the most precise, advanced technique in robotic-assisted technology, allowing a surgeon
greater visualization, dexterity, precision and control, as well as superior ergonomics.
The da Vinci® Surgical System is a sophisticated robotic platform designed to enable
complex surgery through small incisions. It consists of a surgeon’s console, a patient-side
cart with up to four interactive robotic arms, a high-performance 3D high definition
vision system and EndoWrist® instruments which enhance the possible range of motion.
Powered by advanced robotic technology, the da Vinci System is designed to scale,
filter and seamlessly translate the surgeon's hand movements into more precise movements
of the EndoWrist instruments. The net result is an intuitive interface with enhanced
surgical capabilities.
For qualified candidates, robotic prostatectomy offers numerous potential benefits
over traditional open prostatectomy, including:
Robotic prostatectomy received FDA clearance for prostate cancer surgery in the U.S. in May 2001. Since then, the preference of patients and surgeons for the robotic approach to radical prostatectomy has grown, with more than 100,000 procedures performed. Robotic prostatectomy is now the number one treatment choice for prostate cancer in the United States.
Candidates for Robotic Prostatectomy
While each surgical candidate should consult individually in with his urologist, good
candidates for robotic prostatectomy are usually men with localized disease who have
optimal potential for long-term survival post-treatment. Prior surgery and obesity
can add challenges to the procedure, but do not necessarily rule out a man as a candidate.
Men should also discuss whether the location and staging of their prostate cancer
allows for a nerve-sparing procedure (either bilateral or unilateral).
Radical prostatectomy is a complex and delicate procedure due to many factors, including the location of the prostate gland deep inside the pelvis. In radical prostatectomy, the surgeon removes the entire prostate gland along with both seminal vesicles, both ampullae (the enlarged lower sections of the vas deferens), as well as additional surrounding tissues. The surgeon may be able to spare the nerves that run on both sides near the prostate, known as the neurovascular bundles, which can help preserve potency and urinary continence. The section of urethra that runs through the prostate is cut away, and the bladder is re-attached to the remaining section of urethra.
Potential Advantages
In the United States today, surgeons use one of three approaches to radical prostatectomy:
open surgery, laparoscopic surgery and robotic-assisted laparoscopic surgery, of which
the latter two are minimally invasive. An open prostatectomy requires a 3-5 inch incision
in the patient’s abdomen for direct access to the operative site. Conventional laparoscopic
and robotic-assisted laparoscopic approaches require several dime-sized incisions,
or operating “ports,” which are used to introduce narrow-shafted instruments. The
surgeon and assistants maneuver the instruments from outside the body, under vision
provided by a surgical camera.
The potential advantages of laparoscopic and robotic-assisted laparoscopic prostatectomy over conventional open surgery include smaller incisions for less postoperative pain and improved cosmetics, reduced blood loss and less need for blood transfusions, as well as a faster return to normal activities. The two major drawbacks of conventional laparoscopy are its reliance on the use of rigid, hand-held instruments and visualization provided by a standard 2D video monitor. While these technologies enable smaller incisions, they can limit the surgeon’s depth perception, as well as his/her dexterity and precision. Standing at the patient’s side, the surgeon must operate in a counterintuitive fashion, moving the long-shafted instrument handle in precisely the opposite direction of where he or she intends to move the instrument tip. The surgeon maneuvers the instruments while looking up at the 2D view of the operating field projected on a tableside video monitor, and must instruct an assistant on how to position the surgical camera.
In contrast, robotic prostatectomy incorporates state-of-the-art video and robotic technologies that provide natural depth perception and allow a surgeon’s hand movements to be scaled, filtered and translated into precise micro-movements of tiny instruments at the operative site. The superior visualization, enhanced dexterity, precision and control enable the surgeon to perform complex procedures — like radical prostatectomy — through dime-sized operating “ports.” For most patients, da Vinci prostatectomy offers substantially less pain and a shorter recovery period than traditional prostate surgery. Other advantages may include reduced need for blood transfusions, less scarring and lower risk of infection. In addition, recent studies suggest that robotic prostatectomy may offer improved cancer control and a lower incidence of impotence and urinary incontinence.
Additionally, robotic surgery has allowed many surgeons to effectively use nerve-sparing techniques with radical prostatectomy to reduce the risk of impotence and urinary incontinence.
Potential Disadvantages
While clinical studies support the use of the da Vinci® Surgical System as an effective
tool for minimally invasive surgery, individual results may vary. Robotic prostatectomy
remains a surgical procedure, and as such carries inherent risks. Though data supports
high rates of cancer control, maintaining sexual function and return to urinary continence,
there is no guarantee of these benefits to every patient. Also, some individuals may
not be candidates for a full nerve-sparing procedure due to the extent of their cancer.
Results, as with the open operation, are surgeon-dependent and improve significantly
with surgeon experience.