PROSTATE CANCER da Vinci Robot Surgery Cedric Emery, MD. FACS VenturaUrology.com

Every man with Prostate Cancer is unique Every man with Prostate Cancer is unique. The variables in each man are: Age Health PSA Gleason score Stage Personality 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 Brachytherapy (seeds) 3. Cryotherapy (freezing) 4. Surgery Open radical nerve-sparing prostatectomy 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! Read *book/s on prostate cancer Obtain second opinions Ask questions 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 Not sexually active 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 Directs The Instruments The surgeon’s hands are placed in special devices called masters that direct the precise instrument movements

Wrist and Finger Movement Traditional laparoscopic instruments are straight and do not bend EndoWrist® Instruments move like a human wrist Allows increased dexterity, maneuverability, and precision

Small Instruments 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

Benefits of da Vinci™ Prostatectomy Decreased blood loss Shortened length of hospital stay Decreased postoperative pain Less scarring Shorter urinary catheter time Faster return to regular activities Anticipation of improved potency and continence

Robotic-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

Compare the Benefits and Decide What’s Best for You Open Procedure Long Incisions Hospital Stay of 2.5 days Blood Loss 300ml Catheter removal in 21 days 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 Open surgery: mid-19th Century Minimally invasive surgery: late 1980’s Robotic (Intuitive) surgery w/ da Vinci: 1999

da Vinci® Surgical System Surgical Cart 3 to 4 Instrument arms One-piece design for quick set up

da Vinci® Surgical System Surgeon Console Hand to eye alignment Comfortable ergonomic surgeon position NavigatorTM camera control One-piece mobile unit

InSite® 3-D Vision System Superior 3-D imaging ‘Open’ surgery orientation

Degrees Of Freedom

Telestration Facilitate da Vinci® training Easy to use touch panel Route image remotely Being offered in conjunction with Stryker.

Audio Intercom System Two way communication with OR staff Adapts to voice controlled OR systems Picture shown is that of the surgeon’s headrest with two speaker, there is also a microphone and speaker at the patient-side.

A Journey “Taking surgical precision & technique beyond the limits of the human hand.™”