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

2. 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….

3. 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.

4. 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. 5. Hormonal
6. Chemotherapy
7. Immunotherapy

6. 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.

7. 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.

8. 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.

9. 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?

10. 75-year-old male, Gleason 7, rising PSA of 8#1
Heart disease
Not sexually active
Stage T2b
Rx: Consider Cryotherapy

11. 75-year-old male, Gleason 7, rising PSA of 8#2
Healthy
Sexually active
Stage T2b
Rx: Consider da Vinci Radical Prostatectomy

12. 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

13. 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

14. 75-year-old male, Gleason 7, rising PSA of 8#5
Healthy or unhealthy
Sexually active
Stage T4b
Rx: Consider Complete/Intermittent Hormonal Blockade

15. The Surgeon Directs The Instruments
The surgeon’s hands are placed in special devices called masters that direct the precise instrument movements

16. 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

17. 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

18. 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

19. 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

20. 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

21. da Vinci® System Evolution of surgery Open surgery: mid-19th Century
Minimally invasive surgery: late 1980’s
Robotic (Intuitive) surgery w/ da Vinci: 1999

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

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

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

25. Degrees Of Freedom

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

27. 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.

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