Promising new treatment options for prostate cancer

Prostate cancer is the second leading cause of death among American men. It is estimated that one in six males will develop the disease during his lifetime. However, promising new treatment options have been developed to help combat this threatening disease.

One of the most innovative of these treatments is robotic-assisted laparoscopic prostatectomy (removal of the prostate). The University of Pennsylvania Health System is currently one of only a handful of facilities across the country offering this minimally invasive, high-tech treatment. David I. Lee, M.D., a national expert in robotic surgery, was recruited to Penn and named Chief of the Division of Urology at Penn Presbyterian Medical Center, where the robotic prostate program is based.

There are many factors that make robotics an exceptionally valuable tool in the operating room during prostate surgery, for both the patient and surgeon. "Perhaps two of the most-feared possible long-term effects of a radical prostatectomy are erectile dysfunction and urinary incontinence," says Dr. Lee. "My specially-trained team and I have discovered that by using the robotic technique there is greater nerve sparing, which provides patients with the best chance for maintaining potency and continence."

Robotic technology offers a number of advantages during surgery. For instance, the robotic "arms" filter even minute tremors of the human hand so to provide steadiness. The robot's camera also provides a three-dimensional, stereoscopic image of the body's interior, as opposed to a two-dimensional image on a flat screen. This improved perspective enables depth perception sharpens the visualization of the prostate and the network of nerves and tissue surrounding it. Additionally, by scaling down the motion of the robotic instruments, the surgeon can perform extremely precise, intricate movements during the procedure. For example, if the surgeon's hand moves five centimeters, he/she can scale the robotic hand to move only one centimeter.

Robotic technology also offers a number of advantages after surgery. Because laparoscopic surgery is minimally invasive and no large incisions are involved, robotic-assisted surgery provides numerous benefits for prostate cancer patients, including: less pain and scarring, diminished blood loss, a shorter hospital stay and reduced recovery period for a quicker return to daily activities.

The actual robot consists of a tower that manipulates instruments controlled from a console that is situated a few feet from the patient. At the console, the surgeon operates four robotic "arms" and "wrists" using hand and foot controls. One of the robotic arms holds a tiny video camera, one works as a retractor and the other two replicate the surgeon's exact hand movements. The camera and instruments are inserted through small keyhole incisions in the patient's abdomen. The surgeon then directs the robotic instruments to dissect the prostate gland and surrounding tissue.

Unlike standard laparoscopic approaches that require counter-intuitive movements by surgeons (whereby the surgeon must move his hand to the left in order to move the mechanical device to the right), the robotic technology affords surgeons the direct, "intuitive" control they exercise in traditional open surgical procedures, seamlessly translating their natural hand, wrist and finger movements at the console into corresponding micro-movements of laparoscopic surgical instruments inside the patient's body.

Penn has been using fully robotic surgery for cardiac patients for the past three years and is currently studying its use for head and neck cancer surgeries. "The robotic prostate program is a continuation of Penn's commitment to finding and applying the most precise, most beneficial surgical techniques to put patients on a quicker road to recovery with better outcomes," said Dr. Lee.