This is a monthly update on the growth of Robotic Surgery in my practice.

Original blog entry about robotic surgery growth was in November of this year and was updated in December.

For December, I performed 13 robotic operations including 9 prostate removals for cancer, 1 kidney removal for a kidney that was causing pain and was enlarged about 20 times normal and did not work, as well as removing 2 parts of kidneys for cancer.

The highlights for December were:

Dec 19th- I performed what I thought would be one of my most difficult robotic prostatectomies. The gentleman had a severe infection in the past from perforated diverticulitis and and had 2 major colon surgeries. In addition to his prostate cancer, he was left with an incarcerated ventral hernia.

In less than 3 1/2 hours, Dr. Adam Kopelan (Millburn Surgical) and I fixed his hernia and removed his prostate with clean margins. He went home the following day and only took 1 pain pill at home. He told me that it was more for his knee than prostate or hernia surgery.

Dec 19th- We performed our 2nd robotic anterior exenteration and what I think is the worlds first for urethral cancer. This took us about 4 1/2 hours and that included a small incision for the urinary diversion. The details of this can be found at a previous blog entry.

Dec 20th- I performed 2 robotic partial nephrectomies. One patient went home the following day and one patient in 2 days. Both of these were for cancer and had clean margins. This was the 5th operation of this type performed in NJ and all by my robotic team.

Dec 27th- Dr Galdieri and I performed 3 robotic prostatectomy operations in less than 10 hours. This was all done in 1 room and with 1 anesthesiologist and the the same nursing team. This is as much a credit to my anesthesiologist, assistant, nursing team, and all employees involved as it is for myself.

For the year we performed 79 robotic operations and 59 robotic prostatectomies, with a large portion of these the last 3 months.

Posted by Domenico Savatta, M.D. | Permalink | Comments (0) | TrackBacks (0)

Arguably the most difficult operation in urologic surgery is removing the bladder in women for bladder cancer. Our team was the first in the tri-state (NJ, lower NY, CT) area to perform this procedure with the da Vinci robot.

We performed our first robotic anterior exenteration (removing the bladder, urethra, and gynecological organs) in November for muscle invasive bladder cancer. There was very little blood loss (less than 100 ccs or 3 1/2 ozs)and a small incision to perform the urinary diversion and to remove the bladder and other organs in a sac.

We then performed what we believe to be the first robotic procedure for urethral cancer, an operation that is similar to that for bladder cancer, but requires special attention to the urethral area as the margin for cancer control is more difficult to establish. Our second patient also had minimal blood loss.

A review of the literature reveals very few cases like this being done robotically or laparoscopically. The largest laparoscopic series is from the Cleveland Clinic.

The largest series for robotic cystectomies is from Henry Ford in Detroit and Dr. Menon.

Our 2 patients were discharged home in 8 days and 5 days without any complications.

In our hands, we believe most bladder and urethral cancers will be approached robotically and plan on publishing our results.

We think the blood loss is significantly less similar to our experience with robotic prostatectomy and the recovery should be quicker.

Posted by Domenico Savatta, M.D. | Permalink | Comments (0) | TrackBacks (0)

I have noticed after several recent cases that my eyes feel dry and itchy. I think it is due to a reduced blink reflex, a well reconized problem for those working with computer monitors and sometimes called Computer Vision Syndrome.

"Research has shown that the blink rate of VDT workers dropped very significantly during work at a VDT compared to before and after work. Possible explanations for the decreased blink rate include concentration on the task or a relatively limited range of eye movements."

I have made a point of blinking more frequently, looking away from the monitors in the console periodically and taking eye drops like Liquid Tears with me to the OR. Anyone else experiencing this problem or is it just old age (again)?

Dale Russell, MD
Scottsdale Urologic Surgeons

Addendum: since I wrote the above months ago I have found that the best solution comes about on its own as I get more comfortable with the procedure, relax (don't stare at the screens so intently) and get my times down to around two hours on the console or less.

Posted by Dale Russell M.D. | Permalink | Comments (1) | TrackBacks (0)

This is an update from a previous blog entry on robotic surgery growth.

In Nov I performed 10 robotic operations and assisted Dr. Adam Kopelan with a robotic adrenalectomy. Dr. Kopelan is a general surgeon specializing in laparoscopy and one of the few robotic general surgeons. He usually assists me at the field for cases when a urologist and general surgeon are useful including robotic cystectomies, lysis of adhesions prior to prostatectomy, and laparoscopic/robotic hernia repairs in conjunction with prostatectomy.

The most significant days were:

Nov. 21- Dr Kopelan assisted me for the first robotic anterior exenteration performed in the tristate (lower NY, CT, NJ) area.

Nov 30- Dr. Galdieri assisted me in performing 3 dvps in 1 day and all were discharged within 20 hours of surgery.

Posted by Domenico Savatta, M.D. | Permalink | Comments (0) | TrackBacks (0)

Inguinal hernias often coexist in prostate cancer patients.  They can sometimes be found on physical exam or during staging CT scans.  At the time of transperitoneal robotic prostatectomy the inguinal areas are examined with the robotic scope.  If hernias exist, they can be fixed at the time of prostatectomy.. 

When preoperative CT Scan reveals an inguinal hernia or if I feel one on an exam, I have my patient see a laparoscopic general surgeon so the hernia can be fixed at the same time as the robotic prostatectomy.  When the hernias are diagnosed in the operating room, I call a general surgeon to help me fix the hernia.

In the first 52 robotic prostatectomies I performed, 4 had preoperative hernias and a general surgeon was available.  In another 4 cases (4 of 48 or 9%) I found at least one hernia during the operation.  I called a general surgeon to help fix this.  I usually do this robotically while the general surgeon uses the laparoscopic assistant ports.

The technique is as follows:

1.  The hernia is seen on inspection.  With the transperitoneal approach they are obvious.  The picture below shows the hook cautery inside the hernia defect.

2.  Instead of opening the peritoneal cavity in a limited fashion just lateral to the medial umbilical ligaments, I free up the hernia sac by opening the peritoneum widely over to the anterior superior iliac spine. I then remove the contents of the hernia including fat with the robotic instruments.  This is the first half of the robotic hernia repair video.

3. After the robotic prostatectomy is finished we insert a piece of mesh.  Clips are placed into the mesh to anchor it in place.  We then place the peritoneum that was widely opened over the mesh.  The video shows us covering the mesh with anchoring clips.

We have performed 8 of these repairs now, and have changed the closure of the peritoneum to absorbable suture.

We have not had any complications to date and accept a small chance that there may be a mesh infection, as with any mesh surgery to fix the hernia at the same time.  The same incisions are used as for the robotic prostate and this avoids another operation either before or after surgery to fix the hernia.

Click here for dsl/cable modem feed of a robotic hernia repair.

Posted by Domenico Savatta, M.D. | Permalink | Comments (0) | TrackBacks (0)