The Princess Grace Hospital was the first independent hospital in the UK to install a daVinci Surgical Robot enabling the London Urology Associates to offer robotic prostatectomy as a treatment option for prostate cancer. It is a robot-assisted, minimally invasive surgery that is quickly becoming the preferred treatment for removal of the prostate following early diagnosis of prostate cancer.
Aside from robotic prostatectomy, ’radical’ prostatectomy is a well-established treatment for locally advanced occurrences of the disease. In this procedure, the prostate is surgically removed via a 4-6” incision in the lower abdomen. It’s an approach that 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 also 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 medically trained in the UK and the USA, as well as undertaking specific 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 in 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 even possible for the surgeon to operate remotely 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 to know that our surgeons prefer to operate not only from the same continent as the patient, but the same room!
One of the benefits of the daVinci robot is that the surgery can be carried out through a number of much smaller incisions rather than the large incision required for radical prostatectomy; this means that healing time is quicker, there is less scarring, post-operative pain is reduced, a shorter hospital stay is required, 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 helps to minimise blood loss and reduces 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. Though any diagnosis of cancer can be traumatic, the good news is that if prostate surgery has been recommended, the cancer was probably caught early. And, with daVinci Prostatectomy, the likelihood of a complete recovery from prostate cancer without long-term side effects is, for most patients, better than it has ever been.
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 email@example.com.
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.
Laparoscopic Prostatectomyis performed through a number of small incisions using special instruments and a laparoscope to visualise the prostate and surrounding tissue. Laparoscopic surgery offers the benefits of reduced bleeding, less soft tissue damage and shorter recovery period as compared to open prostatectomy. However, laparoscopic surgery should only be done by a specially trained and skilled surgeon to get the best results.
Open Prostatectomy is the traditional form of removing the prostate through one large incision.
Side Effects of Radical Prostatectomy
The side effects for all three forms of treatment are similar; however the percentage of risk is much lower in robotic prostatectomy as compared to open prostatectomy.
- Some risk of long term urinary incontinence
- Some difficulty in achieving erections, but this is usually treatable
- Most men will be infertile due to the absence of ejaculatory fluid
- Risk of urethral stricture (scar tissue)
- Small risk of infection following surgery
- Small risk of bleeding requiring a blood transfusion