Prostate cancer is the most common cancer in men. It is estimated by the American Cancer Society that in 2005 232,090 men will be diagnosed and 30,350 men will die of prostate cancer. The American Cancer Society recommends that early diagnosis testing, consisting of a blood test called prostate specific antigen (PSA) and a digital rectal examination (DRE), begin at age 50 in most men. This is lowered to age 40 in African American men and men who have a family history of prostate cancer. If prostate cancer is diagnosed, further testing may be required to determine if the cancer is localized to the prostate. When cancer is localized to the prostate patients have several choices of effective curative treatments including radical prostatectomy (complete prostate removal) or radiation treatments (including protons). A detailed discussion of the management options with a urologist and other cancer specialists will help clarify the risks and benefits of the various management options.
The US Military initiated research on operating robots as a method of allowing experienced trauma surgeons to operate on battlefield casualties from a remote location.
Recent technological advances have allowed incorporation of robotics into routine clinical care including the radical prostatectomy operation. The concept of using robots in surgery is attractive because it combines the precision and accuracy of a machine with the judgment of an experienced surgeon.
Loma Linda University Medical Center (LLUMC) now has a da Vinci robot to facilitate a less invasive type of radical prostatectomy in selected patients. The da Vinci robot allows the surgeon to remove the prostate through small punctures using pencil sized instruments.
A robotic surgery program requires a committed and specifically trained team of doctors and nurses. Four LLUMC urology surgeons, Drs. Herbert Ruckle, Paul Lui, Duane Baldwin and Gary Barker, completed training on the da Vinci robotic system and have performed several hundred robotic surgeries during the last three years. During the operative procedure the surgeon sits at a controlling console near the patient. A bedside assistant surgeon is next to the patient. As the surgeon watches the operative field though the camera, he controls the robotic arms from the console and the robot arms replicate the surgeon's movements. The cancerous prostate is removed using operative principles of radical prostatectomy refined over the last several decades.
The operating robot has several potential advantages over standard surgical techniques. One advantage is in recovery time. The operation is performed laparoscopically through small punctures and less time is required to heal. Most patients are able to return to normal activity in two to three weeks instead of six to eight weeks with standard open surgery. There is less blood loss when a radical prostatectomy is performed laparoscopically and because of a higher hematocrit (blood count) the patient has more strength and stamina immediately after surgery.
The robot employs a unique camera system allowing the surgeon to enjoy an image at 10 times magnification. The robot's computer fuses the images of two small cameras to give the surgeon a binocular three-dimensional image on the screen. This accurate visualization allows a closer view of the muscles and nerves involved with urinary control and sexual function. By seeing in such detail the surgeon can visually identify the junction of the prostate with the urinary sphincter and precisely cut the urethra leaving the muscles needed for urine control intact. In addition, the magnified view allows the surgeon to see and move aside and out of harm's way the nerves alongside the prostate, which are necessary for erections.
Ultimately, long-term studies will be required to quantify any differences between outcomes of standard open radical prostatectomy and robotically assisted laparoscopic prostatectomy. Careful patient selection is critical to maximize the potential benefit of robotic prostatectomy. Robotic laparoscopic prostatectomy offers a minimally invasive surgical treatment option with the potential for quicker healing and less pain.
See also, publications that support the clinical efficacy of da Vinci Prostatectomy.