Based on statistics by Cancer Research UK, in 2009 it was estimated that 40,841 men were diagnosed with prostate cancer. Up to 10,721 men died from prostate cancer in the UK in 2010. The current statistics highlight the importance of finding new treatment options for prostate cancer. Apart from some of the common treatment methods for this form of cancer including radiation, LHRH agonists/antagonists, and cryotherapy, radical prostatectomy (such as retropubic, perineal, and robot-assisted laparoscopy) offer the most long-term solution to treating this type of malignant neoplasm. The scope of this article discusses the application, challenges and developments in da Vinci-assisted robot prostatectomy.
The da Vinci Robot
A common treatment for prostate cancer is based on removal of the prostate glandular tissue, which carries many more dangers as the incision into the tissue is between 8 to 10 inches and this is considered to encourage a large amount of blood loss, complicate the recovery time, and in certain circumstances this can lead to impotence. Such complications have become the inspiration for developing new less invasive techniques with increased precision – the
da Vinci robot has become the most advanced robotic tool for the safe and precise practice of a prostatectomy. This state-of-the-art surgical system is broken down into the following parts:
Console – this platform allows the surgeon to be seated and observe a 3D image of the precise surgical field. There are a number of controls on the console positioned under the display and these are manually controlled by the surgeon. The controls allow the surgeon to manipulate movement of the surgical instruments positioned inside the surgical field.
Patient-side Cart – This element to the robot consists of up to four robotic instrument arms that perform the surgical procedure under the surgeon’s control (i.e., making an incision). One of the four instrument arms is designed to conduct a laparoscopy. This arm can pivot at a distance of 1–2 cm, which aims to minimise any surrounding tissue from being compromised.
EndoWrist Instruments – these particular instruments have seven degrees of freedom to ensure that this operating instrument mimics the dexterity of the human hand. Again, this flexibility in such operating instruments is based on the need to create a robot with the most precision. Each instrument is designed to perform movements including clamping, suturing and tissue manipulation whilst still maintaining full composition of surround tissue.
Vision System – The 3D imaging system is paramount to providing a detailed view of the operating field.
The following video demonstrates the structural principle to the
da Vinci robot and provides a clear comparison between the benefits of using an advanced intuitive tool and tradition surgical procedures for conducting a prostatectomy.
The next video is a clear 3D animation of a robotic prostatectomy. The video demonstrates how the robotic instruments accomplish movement in many directions to perform incisions in the prostate tissue. The key point to note with this demonstration is that the nerves and blood vessels that are maintain sexual function should still be preserved following completion of the surgical procedure.
Robotic-assisted laparoscopic surgery is minimally invasive.
Open prostatectomy involves making a 5–7 cm incision along the patient’s abdomen to access the operating field. However, with robotic-assisted laparoscopic prostatectomy, there are smaller incisions with less pain, which results in minimal cosmetic damage to the tissue.
Smaller incisions means less blood loss and improved recovery time.
The imaging technology incorporated into the
da Vinci robotic system provides a precise depth of the operating field, allowing full scale of the hand movement, which can be accurately translated into movement of the instrument arms in the operating field. Application of the
da Vinci robotic system for conducting a prostatectomy reduces the chances of the patient experiencing impotence and incontinence due to increased precision during surgery and minimal damage to surrounding blood vessels and nerves.
A successful prostatectomy will vary between patients.
There are still risks with any surgical procedure. Such robot-assisted surgical procedures are surgeon dependent and so the accuracy of outcome will be based on the surgeon’s performance with this system.
The main challenge with robot-assisted prostatectomy is to maintain cancer control and avoid damage to surrounding tissue to help preserve functionality in potency. Robot surgery is beginning to advance as an alternative solution applied in several surgical fields including urology, gynecology, and cardiothoracic specialities. One of the biggest endeavours is to ensure that the surgeon is able to master any new skills associated with the development of surgical robotic systems – standardisation and communication of procedures and control of robots to assist in surgery needs further attention to achieve perfection in manipulating this system.
Sources and Further Reading