This article was submitted to Bexar County Medical Society
Urology, like the rest of medicine, has seen innovations arise at a dizzying pace. Most urologists would agree that their practice of medicine today is dramatically different than what they were trained for at the finish of their residency. Fortunately, urologists have adopted technologies such as robotics if they advance patient care.
Originally conceived for military surgery on the battlefield, robotics has evolved into powerful, state-of-the-art technology adopted for civilian use as the daVinci robotic system (Intuitive Surgical). Radical prostatectomy, which is the removal of the prostate for prostate cancer, quickly became the most common procedure performed with the daVinci robot after FDA approval in 2001. Today, the company estimates 30 to 40% of all prostatectomies performed will be with the robot. San Antonio, through the Baptist Medical System, was an early adopter of this promising technology. As of 2007, over 500 robotic procedures have been performed, with over 400 of these procedures being for prostate cancer.
The System allows the surgeon's hand movements to be scaled, filtered and translated into precise movements of micro-instruments within the operative site. The magnified, three-dimensional view the surgeon experiences enables him to perform precise surgery in complex procedures through laparoscopy. The surgeon sits comfortably at a console, located a few feet away from the patient. The robot “docks” to the laparoscopic ports and a patient-side assistant helps with retraction, suction, and instrument changes.
For qualified candidates, robotically assisted prostate surgery offers numerous potential benefits over the traditional open prostatectomy, including shorter hospital stay, less pain, less risk of infection, less blood loss and transfusions, less scarring, faster recovery, and quicker return to normal activities.
These potential benefits depend on the individual case as well as the experience of the surgeon. Most urologists would agree that learning curve for robotics is steep. For the author, who has personally performed over 400 robotic prostatectomies, an initial comfort level arose at 20 cases and then another level at 150 to 200 cases. This perhaps is the most important point. While the robot is truly a tool capable of improving patient outcomes, its abilities ultimately rest on the surgeon’s experience and skills.
