Prostate news article, April 2007
ROBOTIC SURGERY FOR PROSTATE CANCER. Mr Declan Murphy FRCS Urol Surgeon in receipt of training scholarship from Prostate UK |
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The era of robotic surgery for prostate cancer has well and truly dawned. From about 750 robotic prostatectomies performed worldwide using the da Vinci™ robot in 2002, this number looks set to reach 48,000 in 2007. Robotic-assisted surgery will account for 40% of all radical prostatectomies performed in the USA this year. Unfortunately, access to this technology is much more limited outside the USA. There are 6 da Vinci™ robots in the UK, 2 of which are in private hospitals. Each machine costs over £1 million with running costs of £100,000 per annum.
So what do we mean when we say “robotic surgery” for prostate cancer? It certainly doesn’t imply that an automated machine will have the privilege of carrying out rather delicate surgery on your prostate. The robot is actually controlled by a surgeon who sits at a console a few metres away from the patient (see figure). The machine has 3 (or 4) arms which control a telescope and instruments which are “docked” inside the patient’s body through small ports. The incisions required for these ports measure about 10mm. The view from inside the patient is transmitted to the surgeon’s console in 3D, and using special fingertip controls at the console, he can manipulate the robotic instruments inside the body to carry out delicate keyhole surgery - “remote-control surgery” if you like!
The procedure which has grabbed all the headlines for robotic surgery is Robotic-Assisted Laparoscopic radical Prostatectomy (RALP). In a nutshell, this is removal of the cancerous prostate gland using laparoscopic (“keyhole”) surgery with the assistance of the da Vinci™ robot. While laparoscopic surgery has greatly reduced the morbidity associated with traditional open surgery for a great many surgical procedures, it has not yet gained widespread popularity for the treatment of prostate cancer. The reason for this is quite simply that laparoscopic radical prostatectomy is a difficult procedure which requires intensive training, usually in an overseas centre of excellence. At least 50 cases must be completed before surgeons can become confident of delivering excellent results in an acceptable operative time. The arrival of the da Vinci™ robot has reignited interest in laparoscopic radical prostatectomy as it offers a number of technical features which help overcome the learning curve associated with this challenging procedure. These include:
- Improved vision: The surgeon views a 10X magnified 3D projection inside a special console which improves the accuracy of surgical dissection within the patient. Conventional laparoscopic surgery only allows 2D vision.
- EndoWrist instruments: the da Vinci system allows the use of miniaturised instruments which enable the surgeon to complete movements which are not possible with conventional laparoscopic surgery. This is particularly useful for suturing within the body.
- Ergonomics: the surgeon is seated comfortably at a console which reduces the muscle strain associated with prolonged laparoscopic procedures.
The results of RALP are quite impressive. The procedure is safe and patients are discharged within 1 or 2 days of surgery. Return to normal activities is much quicker than following open surgery. Cancer control rates are excellent and patients regain control of their continence quickly. There is also evidence that surgeons can more effectively perform “nerve-sparing” surgery using the robot, thereby increasing the chances of patients remaining potent following removal of the prostate. It is a combination of all these factors that has lead to the huge current interest in the da Vinci™ robot.
Prostate UK is a strong supporter of robotic surgery in the UK. It is funding ongoing research into this machine through a grant at Guy’s Hospital in London, specifically looking at the ergonomic aspects of robotic surgery. It has also funded a 1 year Travelling Scholarship to enable myself, a senior urology trainee in London, to pursue further training in laparoscopic and robotic surgery at the Royal Melbourne Hospital in Australia. I look forward to returning as a consultant urological surgeon in 2008 to offer laparoscopic and robotic surgery to prostate cancer sufferers in the UK.
Further information:
www.davinciprostatectomy.com
www.urologyatguys.co.uk
www.theprostatecentre.co.uk
