Surgical robot makes prostate removal safe for obese men
Source: News-Medical.Net

"The use of a robotic system could make surgery for prostate cancer an option for thousands of obese men who might otherwise be turned down, report researchers from the University of Chicago in the April 2006 issue of the journal Urology."

I, and I think Dr. Savatta, would agree that one can operate with a robot on the obese and it is sometimes easier than an open.

"Patients were divided into three groups according to weight. Group one consisted of 39 men with a normal body mass index (BMI) of 25 or less. Group two included 65 overweight men, with a BMI between 25.1 and 30. Group 3 contained 46 obese men with a BMI over 30, including three men over 40 and one over 50.

The only statistically significant differences noted between the groups were that the operation took, on average, 60 minutes longer and blood loss was 70cc (2.4 ounces) higher in the obese patients. Otherwise results were similar for all three groups in terms of complications, hospital stay, cancer control and resumption of urinary control and sexual activity.

"We found," the authors wrote, that this operation "can be completed safely in overweight and obese patients, with results similar to those in a cohort of normal-weight patients.""

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Today, Dr. Marc Greenstein and I performed the first robotic diverticulectomy at our hospital, and likely among one of the first on the country.

This procedure was done for recurrent bladder infections, but can also be done for bladder cancer.

The operation went extremely well and much better than the typical open version of the operation. Our robotic time was under 1 hour and there was almost no blood loss, and should cut the patient's hospital stay from 4-5 days to overnight. The expected pain and bladder discomfort should be much less as well.

I will need to update my website and add some video when I get the chance, as well as submit a paper for publishing.

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Our friendly nephrologist at kidneynotes.com found this article:
USATODAY.com - Robot birth simulator gaining in popularity

I was giving a grand round recently and was asked by the chairman of medicine about other robots in medicine. I told the audience of the robotic doctor and robotic scrub nurse, but I think this list will grow in the next few years.

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NU robots designed to train doctors to operate in outer space
Source: Lincoln Journal Star

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Although there is a growing number of prostates being removed robotically, there are many people and top urologists questioning the benefit of the da Vinci prostatectomy over the established open approach. This was recently debated on ABC News.

I do find it interesting in that how some urologists that I deeply respect are heavily in favor of it, including one of my mentors at Indiana University, Dr. Koch.

One person who I have failed to meet as of yet, is a urologist who has performed a lot of these procedures, and then decided that the robot was not necessary and reverted back to the regular laparoscopic or open approach.

Many of the top open prostate surgeons are now performing robotic prostatectomies.

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Scouting the blog world, I found an excellent blog from another urologist:
Uro Stream: RANDOM THOUGHTS AND RANTS FROM YOUR FRIENDLY UROLOGIST

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Analysis: Robot's financial impact mixed

I am extremely pleased that Dr. Shalhav has become one of the top minimally invasive surgeons in the United States. As a 3rd year urology resident in 1999 I had the fortune of working with Dr. Shalhav. He was an excellent teacher and was the first exposure I had to minimally invasive urology. We spent time together performing research in the lab and surgery in the operating room. The majority of the reason why I have been as successful as I have with minimally invasive surgery is what I learned from Dr. Shalhav and the other world class surgeons at Indiana University.

Source: United Press International

We have seen something similar at our hospital. Our hospital had been loosing money on every case, but now is profitable per case.

Our 1st 3 hour robotic prostatectomy was our 8th operation if you looked only at the robotic part of the operation.
Looking at the entire operation, including robotic/laparoscopic setup at the start and undocking/specimen removal/wound closure it took until operation 30 to finish in less than 3 hours.

We have lowered our operating room times by using the same nurses and anesthesiologists and concentrating on all aspects of the operation. We have cut down our initial robotic and laparoscopic setup time from over an hour to 15 minutes and the final step from 30 minutes at the end to 15 minutes.

Our fastest operation has been 1 hour and 40 minutes, but on average it is about 2 hours and 30 minutes after 100 da vinci prostatectomies.

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I am often asked about other robotic surgical platforms other than Intuitive's Da Vinci Surgical System.

There currently aren't any systems that are being used to perform laparoscopic surgery to my knowledge. Prior to 2003, when Computer Motion merged with Intuitive Surgical, Computer Motion had a product called the Zeus surgical system.

This system had a flat screen 2-D monitor and didn't have endowrist instruments. I believe the movement of the instruments was not intuitive, but more like regular laparoscopy (this may have been upgraded prior to its retirement). One nice feature of the Zeus was the AESOP camera system, which was voice activated and gave a still picture. This was a small upgrade overall to conventional laparoscopic surgery, but not in the same class as the current da Vinci system.

I found a picture of the system online at thinkquest.org.

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

As I explained last month, I have been restricting use of the da vinci robot to prostate surgery. Until our second robot is operational on a regular basis, I have been mostly performing davinci prostatectomy (dvP) for prostate cancer.

In March, despite one week of vacation, I performed 13 robotic operations. One was an elderly gentleman who had a robotic cystoprostatectomy. The other 12 were dvPs. To date I have performed 121 robotic operations with 93 done for prostate cancer (77%).

The highlights for the month were:

12 robotic prostate cancer surgeries, the most in my practice for 1 month.
5 robotic prostates in 1 week, also the most for 1 week.
All 12 prostate cancer patients had negative margins on the pathology report, which makes 26 consecutive patients with negative margins (About 15% would be very good and anything under 10% is excellent). This should lead to excellent long term cancer control.

One patient had a problem that I have never seen before in my almost 100 dvPs or any of the open prostatectomies that I have performed. After doing well for several days, his urine stopped draining from the catheter. It seems that when the catheter settled at the connection site between the bladder and urethra, it made the urine drain preferentially out the connection and into the belly. This required a hospital stay and a small drain placed into the abdomen. This healed without further surgery, but required me to push the catheter away from the connection several times until I taped the catheter in a way that it would stay away from the connection.

The only thing that was unusual about his surgery was that his urinary drainage tubes (ureters) were placed very close to the bladder neck. Ive seen this several times before with robotics and never had this problem before.

This was the first major complication that we suffered in our robotic prostate series to date. I am glad to say that at his 1 month visit, he already had excellent urinary control. If other urologists ever have this problem, please contact me and we can discuss this rare complication.

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I have added an easy way to subscribe to the robotic surgery blog.

I will be linking to feedburner, which will allow you to subscribe to the blog by importing entries into your my yahoo, google home page, etc.

The link is on the right nav:

Subscribe to Blog (RSS) >>

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Source: National Post (Canada)