Presentation on theme: "PROSTATE CANCER da Vinci Robot Surgery Cedric Emery, MD. FACS VenturaUrology.com."— Presentation transcript:
PROSTATE CANCER da Vinci Robot Surgery Cedric Emery, MD. FACS VenturaUrology.com
Every man with Prostate Cancer is unique. The variables in each man are: 1. Age 2. Health 3. PSA 4. Gleason score 5. Stage 6. Personality 7. and more….
Today there are approximately 250,000 new diagnoses of Prostate Cancer yearly – most are cured. In 1970, most men died of complications from obstruction, kidney failure or bone pain.
TREATMENTS 1. Watchful waiting 2. Radiation External IMRT External IMRT Brachytherapy (seeds) Brachytherapy (seeds) 3. Cryotherapy (freezing) 4. Surgery Open radical nerve-sparing prostatectomy Open radical nerve-sparing prostatectomy Robotic da Vinci Radical nerve sparing Robotic da Vinci Radical nerve sparing
5. Hormonal 6. Chemotherapy 7. Immunotherapy
da 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.
You Are Fortunate The 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.
Your Job! 1. Read *book/s on prostate cancer 2. Obtain second opinions 3. Ask questions 4. Decide which treatment option best suits your needs. * The Prostate; A Guide For Men and the Women Who Love Them, by Pat Walsh, MD.
EXAMPLE 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?
75-year-old male, Gleason 7, rising PSA of 8 #1 Heart disease Heart disease Not sexually active Not sexually active Stage T2b Stage T2b Rx: Consider Cryotherapy
75-year-old male, Gleason 7, rising PSA of 8 #2 Healthy Sexually active Stage T2b Rx: Consider da Vinci Radical Prostatectomy
75-year-old male, Gleason 7, rising PSA of 8 #3 Healthy Sexually active Large obstructing prostate with slow stream Stage T2b Rx: Consider Open Radical, nerve-sparing, Prostatectomy
75-year-old male, Gleason 7, rising PSA of 8 #4 Healthy or Unhealthy Sexually active Stage T3b Rx: Consider Radiation: IMRT, Seeds or both
75-year-old male, Gleason 7, rising PSA of 8 #5 Healthy or unhealthy Sexually active Stage T4b Rx: Consider Complete/Intermittent Hormonal Blockade
The surgeon’s hands are placed in special devices called masters that direct the precise instrument movements The surgeon’s hands are placed in special devices called masters that direct the precise instrument movements The Surgeon Directs The Instruments
Traditional laparoscopic instruments are straight and do not bend Traditional laparoscopic instruments are straight and do not bend EndoWrist ® Instruments move like a human wrist EndoWrist ® Instruments move like a human wrist –Allows increased dexterity, maneuverability, and precision Wrist and Finger Movement
da Vinci ® Surgical System EndoWrist ® Instruments are small and are able to fit through keyhole incisions da Vinci ® Surgical System EndoWrist ® Instruments are small and are able to fit through keyhole incisions A wide range of instruments are available A wide range of instruments are available Small Instruments through Keyhole Incisions
Benefits of da Vinci™ Prostatectomy Decreased blood loss Decreased blood loss Shortened length of hospital stay Shortened length of hospital stay Decreased postoperative pain Decreased postoperative pain Less scarring Less scarring Shorter urinary catheter time Shorter urinary catheter time Faster return to regular activities Faster return to regular activities Anticipation of improved potency and continence Anticipation of improved potency and continence
Robotic-Assisted Surgery Access Open Surgical Incision da Vinci ™ Prostatectomy Incision
Compare the Benefits and Decide What’s Best for You Open Procedure Open Procedure –Long Incisions –Hospital Stay of 2.5 days –Blood Loss 300ml –Catheter removal in 21 days Robotic-Assisted Procedure Robotic-Assisted Procedure –5 or 6 small keyhole incisions –Hospital stay of 1.2 days –Blood Loss 153 ml –Catheter removal in 7 days –Back to work in 2 weeks
da Vinci ® System Evolution of surgery Evolution of surgery –Open surgery: mid-19 th Century –Minimally invasive surgery: late 1980’s –Robotic (Intuitive) surgery w/ da Vinci: 1999
3 to 4 Instrument arms 3 to 4 Instrument arms One-piece design for quick set up One-piece design for quick set up da Vinci ® Surgical System Surgical Cart
Hand to eye alignment Comfortable ergonomic surgeon position Navigator TM camera control One-piece mobile unit da Vinci ® Surgical System Surgeon Console
Superior 3-D imaging ‘Open’ surgery orientation InSite ® 3-D Vision System
Degrees Of Freedom Degrees Of Freedom
Telestration Facilitate da Vinci® training Easy to use touch panel Route image remotely
Audio Intercom System Two way communication with OR staff Adapts to voice controlled OR systems
A Journey A Journey “Taking surgical precision & technique beyond the limits of the human hand.™”