“Once you go robotic, you don’t go back,” said Dr. Felix Badillo, a urologist and chief of robotics at North Shore University Hospital in Manhasset.
Dr. Badillo has been removing prostates while sitting about five feet away from the patient, with the help of the Da Vinci Surgical System, since July. It uses a robot to translate the surgeon’s hand movements into smaller more precise manipulations within the patient’s body.
For the doctor, the benefits of using the robot are the three-dimensional view that the surgeon gets during the surgery and the ability to precisely manipulate tiny instruments with more range than the human hand. For patients, the smaller incisions mean less blood loss, shortened catheterization and a faster, less painful recovery.
Prostate cancer is the second most common cancer in men, after skin cancer. And it is second to lung cancer as the leading cause of cancer-related death. The most common treatment for men with prostate cancer under 70 is a radical prostatectomy, which is the removal of the entire prostate gland.
In traditional open prostate surgery, the doctor would make an incision in the lower abdomen and then remove the prostate, surrounding tissue and lymph nodes through this incision. The procedure was invasive and involved significant blood loss.
Later developments in laparoscopic surgery allowed the surgeon to see inside the patient with small cameras inserted through five smaller incisions in the abdomen. The surgeon was guided by the laparoscope, which transmits a picture of the prostate onto a video monitor. This type of surgery reduced recovery time and blood loss for the patient.
The Da Vinci robot is even less invasive than laparoscopic surgery. The instruments used in laparoscopy are rigid, wheras the Da Vinci instruments can move with even more flexibility than the human hand. The result is that patients require fewer days with a catheter and even less blood loss.
One of the arms holds a camera, which provides a three-dimensional, highly magnified view of the operating area. The other two arms, completely controlled by the surgeon, do the work of removing the tumor and surrounding tissue.
It took four years for North Shore Hospital to get the robot. At $1.5 million, the Da Vinci System, made by Intuitive Surgical, is not cheap. It also requires years of training for surgeons, nurses and technicians. Dr. Badillo trained at the company’s headquarters in Hackensack for three years before beginning to use the machine in his practice.
After 20 years performing traditional open prostatectomies, Dr. Badillo will only use the robot now. “As a surgeon, I’m always trying to improve my technique,” he said. It is a great teaching tool too, he added, because students can practice in nearly the same environment as real surgery.
The only drawback, according to Dr. Badillo, is that the robotic surgery takes longer than traditional open surgery. When a doctor is first starting out with Da Vinci, it will often take five hours to complete a prostatectomy. With more experience, it can be reduced to two to three hours.
Elmhurst Hospital purchased its first Da Vinci System in August, which it uses for prostatectomies as well as kidney and gall bladder removals. They have done two prostatectomies since then. “I’m dying to get my third case,” said Attending Physician Dr. Nabet Kasabian. “There’s no question about the advantages.”
The Da Vinci System was initially developed under a research grant from the U.S. Army. The original government grant was awarded to Dr. Frederick Moll to explore the possibility of highly skilled surgeons working in a battlefield environment without being in harm’s way. After realizing it wasn’t an ideal technology for battle, Dr. Moll pursued robotic technology for minimally-invasive surgery, founding Intuitive Surgical in 1995. Since its introduction, sales of the systems have been increasing steadily.