- The Washington Times - Thursday, October 14, 2004

Robotically assisted prostate-cancer surgery is not routine, but a surgeon who performs it weekly at Inova Fairfax Hospital says it should be within 10 years.

“By all measures, this has all the probability of replacing old-fashioned [prostate] surgery” within a decade, said Dr. Simon Chung, co-director of laparoscopic urology at the hospital in Alexandria, where he has been performing an average of four such operations a week since June.

“It’s so much more accurate, there’s not a choice … to say it’s fantastic is an understatement,” Dr. Chung said.

Dr. Jason Engel, clinical director of urologic laparoscopy at George Washington University Medical Center, agreed. The center began offering the robotic surgery in January and now averages 45 such procedures weekly.

And so do patients, the two doctors say, because of the surgery’s major advantages. Benefits include significantly less blood loss during the operation, less pain and scarring afterward, shorter catheterization time, earlier discharge from the hospital and a far quicker recovery period.

Especially important for many men, the doctors said, the higher-tech surgery reduces the risk of incontinence and minimizes the risk of sexual impotence, two of the main complications associated with conventional prostate-cancer surgery.

About 16 percent of American men will be diagnosed with prostate cancer sometime in their life. Prostate cancer is the second deadliest cancer in men, behind lung cancer.

Today, one of the most common treatments for prostate cancer involves the surgical removal of the prostate gland, known as radical prostatectomy. Traditional radical prostatectomy is open surgery that requires a large 8-inch to 10-inch incision.

But now, George Washington, Inova Fairfax and Walter Reed Army Medical Center offer a less invasive, state-of-the-art prostate surgical procedure called da Vinci prostatectomy.

The $1.2 million da Vinci Surgical System, developed by Intuitive Surgical Inc. of Sunnyvale, Calif., is powered by robotic technology and enables complex operations to be performed through tiny surgical openings.

“They are like little Band-Aid incisions,” said Ryan Rhodes, spokesman for Intuitive Surgical.

The da Vinci system consists of a surgeon’s console, a patient side cart with four interactive robotic arms, a high-performance vision system and instruments that work like wrists.

“The instrument robots have wrists so they can twist and turn in very small spaces,” Dr. Chung said.

Dr. Engel said the da Vinci system helps the surgeon see anatomical structures more clearly and operate more precisely.

“With normal laparoscopic surgery, there is no depth perception. But this da Vinci system creates true 3-D dimensions,” he explained.

The system cannot be programmed, nor can it make decisions on its own.

“I’m totally in charge. I am doing the entire surgery. There is absolutely no autonomous movement” by the robotic arms, Dr. Engel said, adding, “The robots are tools that allow me to do far more advanced laparoscopic surgery. They allow me to tackle harder things.”

As for blood loss, Dr. Engel said the average in an open radical prostatectomy is 800 to 1,000 cubic centimeters, but using the da Vinci system, the average lost is 50 to 100 ccs.

Dr. Chung said patients who undergo the da Vinci procedure typically are discharged from the hospital at least a day earlier.

“And the need for pain medication is almost nonexistent. Those who have had a da Vinci prostatectomy only have to take one to three tablets for pain. But those who undergo the open surgery take 30 to 50 tablets over a four-week period,” he said.

“My patients fully recover in one to two weeks, instead of one to two months,” Dr. Engel added.

Dr. Chung admits that he was “initially doubtful” about the benefits of the procedure.

“I thought it was a gimmick,” he said, but he does not think so anymore.

Worldwide, 243 da Vinci surgical systems are in use, of which 171 are in the United States. Europe has 51, and the rest are spread through the rest of the world, he said.

Mr. Rhodes said those numbers are pretty amazing, given that the robotic procedure is “only three years old.” He said the robotic surgery has a “very high success rate,” adding, “It is at least equal to the current standard of surgery, not factoring in all the benefits” the robotic procedure offers.

He added that it’s “not uncommon” for men in states where the technology is not available to travel to states where it is.

“We’ve heard of some patients who left Canada and came to the United States for this surgery. One patient went from Canada to Switzerland,” he said.

Dr. Engel said he has had patients from as far away as China.

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