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Surgeons and Robots

Minimally invasive technologies transform the landscape of cancer surgery. 

BY BEVERLY A. CALEY
PUBLISHED MONDAY, JUNE 11, 2007
Talk about this article with other patients, caregivers, and advocates in the Prostate CURE discussion group.
“The future of cancer surgery is minimally invasive surgery,” and the future of minimally invasive surgery is to move beyond the human hand and bring the power of computers into the operating room. That’s the outlook according to Mani Menon, MD, a pioneer in the field of robotic surgery.

Dr. Menon, director of the Vattikuti Urology Institute at the Henry Ford Health System in Detroit, says, “Robotics is really a different way of doing surgery. What we’re doing is merging the power of computers and information technology with the mind and the hands of the surgeon.”

Robotic surgery, a concept first developed by NASA during the 1970s, can have dramatic benefits for today’s patients. Dr. Menon recently operated on a kidney cancer patient who was diabetic, had survived a stroke, and had numerous other health problems. The surgical team removed his kidney robotically and the patient was able to go home just 12 hours later.

One early robot commonly used in cancer surgery was the automated endoscope system for optimal positioning, or AESOP. The first AESOPs allowed surgeons to control the robotic arm manually, with a foot switch or a hand control. Further changes to the AESOP system resulted in the ZEUS robot, which combined an AESOP for holding a camera with two additional robotic arms to hold surgical tools. The ZEUS robot is now being phased out and a new robot, called the da Vinci Surgical System, is favored by today’s surgeons.

You can use the robot to place the camera anywhere in the body, whereas in open surgery, you are just looking at what you can see from above.

The da Vinci, the only surgical robot approved by the Food and Drug Administration, has two main sections: a control console and a surgical cart holding four robotic arms—one with a camera and the other three holding the surgical instruments. The camera provides a magnified three-dimensional view inside the patient’s body, while the tiny surgical instruments are controlled by the surgeon using hand tools. The robot filters hand tremors, allowing for more precise control of fine movements than the human hand.

The da Vinci Robot“You can use the robot to place the camera anywhere in the body, whereas in open surgery, you are just looking at what you can see from above,” Dr. Menon says. In addition, software can be used to enhance images, block out colors, and adjust for minor points of bleeding.

Patients who have a robotically assisted prosta-tectomy have an average hospital stay of a little over one day compared with about three to four days for an open procedure. In addition, the use of the technique developed by Dr. Menon results in a return of erectile function within one year in 97 percent of patients compared with 74 percent with the conventional procedure.

This information was highly persuasive to Marlin Mallory. When he was diagnosed with prostate cancer in 2006 at age 43, he consulted two urologists. One strongly recommended a minimally invasive procedure using the da Vinci system, and the other strongly recommended an open procedure. “As an engineer, I seek information when I don’t like the way things are.” So Mallory studied the data and decided the robotic procedure was the way he wanted to go.

Dr. Menon says although he never directly sees or touches the patient, the device and procedure feels very natural. “Your sense of touch is actually enhanced, because visual cues from changes of tissue that can be seen on the monitor are much more sophisticated than actual touching. So you end up doing a much more precise operation because you see changes you never would have been able to see otherwise.”

When I see someone now who needs surgery, I ask my associates, ‘Can I do this better with the robot than I can do it open?’ Ninety-five percent of the time, the answer is yes.

Surgeons at the Vattikuti Urology Institute have used the da Vinci robot for 28 different kinds of procedures, including “every possible urological kind of cancer,” according to Dr. Menon. “We’ve used it to fix problems caused by radiation treatment in the bladder and vagina. When I see someone now who needs some kind of surgery, I ask my associates, ‘Can I do this better with the robot than I can do it open?’ Ninety-five percent of the time, the answer is yes. In the other 5 percent of cases, the procedure is so simple that the robot doesn’t add anything, or the procedure is so difficult that I don’t want to do it with the robot. It does take some time to develop these procedures.”

In addition to prostatectomy, the da Vinci system is routinely used for hysterectomy to treat cervical and endometrial cancer, gastric bypass, and mitral valve repair. The robot may soon be used for some bladder cancers as well as thoracic procedures.

Robotic systems have some drawbacks. Currently, about 400 facilities in North America have a da Vinci at a cost of about $1.5 million per robot with disposable equipment costs and annual maintenance fees included, according to da Vinci manufacturer Intuitive Surgical.

Talk about this article with other patients, caregivers, and advocates in the Prostate CURE discussion group.
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