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Robotic Surgery
The Princess Grace Hospital is the first independent hospital to have the daVinci Surgical Robot in the UK and the London Urology Associates are now offering robotic prostatectomy as a treatment option for prostate cancer.
Radical prostatectomy is a well-established treatment for locally advanced prostate cancer. In this procedure the prostate is surgically removed via a 4-6” incision in the lower abdomen. This approach allows the prostate to be visualised and removed in its entirety; it is important that all cancerous tissue is removed during the procedure to minimise the risk of recurrence.
One of the drawbacks of radical prostatectomy is the size of incision: it obviously takes time to heal, can cause post-operative pain and limits mobility in the days after the procedure. Laparoscopic (keyhole) prostatectomy has been used in some centres but is limited by its technical difficulty.
The daVinci surgical robot was first introduced to the medical community in 1999 and now there are more than 300 robots in use worldwide. The technology is currently being used for cardiac, urological, gynaecological and general surgery.
Chris Ogden has been trained in the UK and the USA and had his daVinci training in Paris. The first daVinci prostatectomy to be carried out in the private sector was performed by Chris Ogden and his colleagues at the Princess Grace Hospital in August 2005 (see Times article).
The robot itself consists of two units. The Patient-side cart has four robotic arms for carrying out the surgery; one arm holds a camera and the other three hold instruments. The surgeon sits at a console with a stereoscopic 3D view of the operating field. Unlike a conventional (2D) screen, this allows the perception of depth which makes accurate surgery much easier. Beneath the display are the master controls which translate the surgeon’s hand movements real-time to the movement of the robotic arms and instruments. The system is designed to remove tremor and allow very precise movements.
It is possible for the surgeon to operate remote from the patient; in 2001 a patient in France had his gallbladder removed by a team of surgeons in New York using a high-speed data connection. You will be pleased that our surgeons prefer to operate not only from the same continent as the patient, but the same room!
As mentioned before, conventional open radical prostatectomy requires a large incision to be made in the lower abdomen to allow the surgeon access to the pelvis and prostate. One of the benefits of the daVinci robot is that the surgery can be carried out through a number of much smaller incisions; this means that healing time is quicker, post-operative pain is reduced and patients are likely to return to normal activities sooner. Additionally, the view of the surgical field afforded by the 3D stereoscopic display means that the surgeon has a much clearer view of the nerves and blood vessels surrounding the prostate which may help to minimise blood loss and reduce the risk of damaging the nerves responsible for continence and erectile function.
Prostate cancer varies a great deal in its aggressiveness and some treatments are more appropriate than others for individual patients. For further advice you should discuss the treatment options with your urologist. If you would like to arrange an appointment with one of our specialists, please call 020 7224 5089 or e-mail info at lua dot co dot uk.
Further reading
Intuitive Surgical Manufacturers of daVinci robot
22nd August 2005 The Times Remote Control by Dr Thomas Stuttaford
27th July 2005 Forbes.com Going under the daVinci
27th December 2005 Daily Mail A robot cut out my prostate (a patient of Mr Ogden's talks about the procedure)
2005 The Economist Return of the Robots
Urology. 2004 May;63(5):819-22. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon's outcomes. Ahlerling et al.