State-of-the-art laparoscopic robotic technology sends most prostate patients home the day after surgery

Aug 2 2004

As recently as three years ago, the gold standard to treat prostate cancer, the second most common form of cancer in men, was an invasive surgery that required up to a one-week hospital stay.

Today, at the Wilmot Cancer Center at Strong, men are benefiting from state-of-the-art laparoscopic robotic technology, which allows surgeons to use a minimally invasive approach, and send most patients home the day after surgery.

The man leading the minimally invasive robotic charge at Strong Memorial is Jean Joseph, M.D., who has completed more than 200 surgeries, nearly two-thirds of them with the new daVinci Robotic Surgical System, making him one of the top 10 most experienced laparascopic surgeons in the country. Joseph, who directs the Urology Department’s Section of Laparascopy and Robotics, is performing about six robotic surgeries each week, taking under three hours for each procedure, about the same time as a traditional prostetectomy.

Strong was the first in upstate New York to offer this technology, adding the system in early 2003 to allow urology and cardiac surgeons to perform procedures laparoscopically, eliminating the need for large incisions. The leading-edge technology consists of a robotic arm that performs surgeries using movements that replicate a surgeon’s motions. The movements are controlled from across the room, by a surgeon using virtual 3-D images provided by laparoscopic cameras.

“This system gives the appearance of being inside the patient,” says Joseph. “The 3-D view provides a depth perception that is missing in traditional laparoscopic surgery. This brings us as close to the surgical site as we can get. In fact, the magnified 3-D view enhances the images, helping to improve accuracy and precision,” Joseph said.

The benefits of the robotic technology have a significant impact on patients and their outcomes. Because the cases are done laparoscopically, dime-sized incisions are made that result in faster recovery time and a lower chance of infection or other complications such as incontinence and impotence. The procedures themselves can be even more accurate than traditional surgery, with steadier “hands” at the surgical site being directed by a surgeon.

Using the robotic surgical system, patients are surrounded by medical personnel, yet the surgeon is located at a console a few feet away. Supporting surgical team members prepare small incisions in the patient, install the correct instruments, and supervise the laparoscopic arms and tools being used. The instruments are designed with seven degrees of motion to mimic the dexterity of the human wrist. Each instrument has a specific surgical mission such as clamping, suturing and tissue manipulation.

Although the surgeon is not physically in contact with the patient, the daVinci control console allows the surgeon to actually see the surgical field in enhanced detail as a result of the three-dimensional image transmitted from the laparoscopic cameras.

The surgeon manipulates the robotic “hands” in real-time using master controls, seeing minute, 3-D details inside the patient with the aid of the cameras located inside the patient. The two robotic arms and one laparoscopic arm execute the surgeon’s commands.

The robotic system also enhances the accuracy of delicate maneuvers such as repetitive stitching and suturing. “It’s almost like comparing a sewing machine to hand stitching,” Joseph says.

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