One of the most innovative of thesetreatments is robotic-assisted laparoscopic prostatectomy (removal ofthe prostate). The University of Pennsylvania Health System iscurrently one of only a handful of facilities across the countryoffering this minimally invasive, high-tech treatment. David I. Lee,M.D., a national expert in robotic surgery, was recruited to Penn andnamed Chief of the Division of Urology at Penn Presbyterian MedicalCenter, where the robotic prostate program is based.
There aremany factors that make robotics an exceptionally valuable tool in theoperating room during prostate surgery, for both the patient andsurgeon. “Perhaps two of the most-feared possible long-term effects ofa radical prostatectomy are erectile dysfunction and urinaryincontinence,” says Dr. Lee. “My specially-trained team and I havediscovered that by using the robotic technique there is greater nervesparing, which provides patients with the best chance for maintainingpotency and continence.”
Robotic technology offers a number ofadvantages during surgery. For instance, the robotic “arms” filter evenminute tremors of the human hand so to provide steadiness. The robot’scamera also provides a three-dimensional, stereoscopic image of thebody’s interior, as opposed to a two-dimensional image on a flatscreen. This improved perspective enables depth perception thatsharpens the visualization of the prostate and the network of nervesand tissue surrounding it. Additionally, by scaling down the motion ofthe robotic instruments, the surgeon can perform extremely precise,intricate movements during the procedure. For example, if the surgeon’shand moves five centimeters, he/she can scale the robotic hand to moveonly one centimeter.
Robotic technology also offers a number ofadvantages after surgery. Because laparoscopic surgery is minimallyinvasive and no large incisions are involved, robotic-assisted surgeryprovides numerous benefits for prostate cancer patients, including:less pain and scarring, diminished blood loss, a shorter hospital stayand reduced recovery period for a quicker return to daily activities.
Theactual robot consists of a tower that manipulates instrumentscontrolled 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 tinyvideo camera, one works as a retractor and the other two replicate thesurgeon’s exact hand movements. The camera and instruments are insertedthrough small keyhole incisions in the patient’s abdomen. The surgeonthen directs the robotic instruments to dissect the prostate gland andsurrounding tissue.
Unlike standard laparoscopic approaches thatrequire counter-intuitive movements by surgeons (whereby the surgeonmust move his hand to the left in order to move the mechanical deviceto the right), the robotic technology affords surgeons the direct,“intuitive” control they exercise in traditional open surgicalprocedures, seamlessly translating their natural hand, wrist and fingermovements at the console into corresponding micro-movements oflaparoscopic surgical instruments inside the patient’s body.
Pennhas been using fully robotic surgery for cardiac patients for the pastthree years and is currently studying its use for head and neck cancersurgeries. “The robotic prostate program is a continuation of Penn’scommitment to finding and applying the most precise, most beneficialsurgical techniques to put patients on a quicker road to recovery withbetter outcomes,” said Dr. Lee.
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