6da Vinci Robotic Prostatectomy I will discuss today the da Vinci Robotic surgery, which we have had here at CMH for the past two years.But first, let me show you how patients can choose the ideal therapy for themselves.
7You Are FortunateThe great thing about our CMH Hospital and community is that we offer all these treatment options.The physicians in our community who utilize these options are excellent.You are fortunate to have our hospital as your home base.
8Your Job! Read *book/s on prostate cancer Obtain second opinions Ask questionsDecide which treatment option best suits your needs.* The Prostate; A Guide For Men and the Women Who Love Them, by Pat Walsh, MD.
9EXAMPLE CASES What treatment would be best for these men? Let’s take 5 patients with three variables made the same: Age 75, Gleason 7, rising PSA of 8.What do you think?
1175-year-old male, Gleason 7, rising PSA of 8 #2HealthySexually activeStage T2bRx: Consider da Vinci Radical Prostatectomy
1275-year-old male, Gleason 7, rising PSA of 8 #3HealthySexually activeLarge obstructing prostate with slow streamStage T2bRx: Consider Open Radical, nerve-sparing, Prostatectomy
1375-year-old male, Gleason 7, rising PSA of 8 #4Healthy or UnhealthySexually activeStage T3bRx: Consider Radiation: IMRT, Seeds or both
1475-year-old male, Gleason 7, rising PSA of 8 #5Healthy or unhealthySexually activeStage T4bRx: Consider Complete/Intermittent Hormonal Blockade
15The Surgeon Directs The Instruments The surgeon’s hands are placed in special devices called masters that direct the precise instrument movements
16Wrist and Finger Movement Traditional laparoscopic instruments are straight and do not bendEndoWrist® Instruments move like a human wristAllows increased dexterity, maneuverability, and precision
17Small Instruments through Keyhole Incisions da Vinci® Surgical System EndoWrist® Instruments are small and are able to fit through keyhole incisionsA wide range of instruments are available
18Benefits of da Vinci™ Prostatectomy Decreased blood lossShortened length of hospital stayDecreased postoperative painLess scarringShorter urinary catheter timeFaster return to regular activitiesAnticipation of improved potency and continence
19Robotic-Assisted Surgery Access The differences between Robotic-Assisted Surgery and the traditional open procedure are the way we access the prostate and other anatomy.In the open procedure on the left, we had to make a long incision down the center of the abdomen.In the Robotic-Assisted Procedure on the right, we make several small “key hole” incisions. These access points allow us to insert a high-powered 3-dimensional camera as well as robotic instruments into the abdomen. We can now see, under high-magnification, the prostate and surrounding anatomy. We can then perform a precise & delicate operation with the robotic instruments.Open Surgical Incision da Vinci™ Prostatectomy Incision
20Compare the Benefits and Decide What’s Best for You Open ProcedureLong IncisionsHospital Stay of 2.5 daysBlood Loss 300mlCatheter removal in 21 daysRobotic-Assisted Procedure5 or 6 small keyhole incisionsHospital stay of 1.2 daysBlood Loss 153 mlCatheter removal in 7 daysBack to work in 2 weeks
21da Vinci® System Evolution of surgery Open surgery: mid-19th Century Minimally invasive surgery: late 1980’sRobotic (Intuitive) surgery w/ da Vinci: 1999
22da Vinci® Surgical System Surgical Cart 3 to 4 Instrument armsOne-piece design for quick set up
23da Vinci® Surgical System Surgeon Console Hand to eye alignmentComfortable ergonomic surgeon positionNavigatorTM camera controlOne-piece mobile unit
24InSite® 3-D Vision System Superior 3-D imaging‘Open’ surgery orientation
26Telestration Facilitate da Vinci® training Easy to use touch panel Route image remotelyBeing offered in conjunction with Stryker.
27Audio Intercom System Two way communication with OR staff Adapts to voice controlled OR systemsPicture shown is that of the surgeon’s headrest with two speaker, there is also a microphone and speaker at the patient-side.
28A Journey“Taking surgical precision & technique beyond the limits of the human hand.™”