* Prostate Cancer * Kidney Cancer

• W. Jason Cook, M.D.
• Cole Davis, M.D.
• Sean Doyle, M.D.
• Marc Milsten, M.D.
• Andrew Wright, M.D.

At USO Urologists performed the first robotic prostatectomy using the da Vinci robot in Tulsa, Oklahoma 2005. Since that time USO has performed over 1200 robotic surgeries. USO has continued as a minimally invasive center of excellence and was the first in Oklahoma to perform a robotic partial nephrectomy (removal of a tumor from the kidney) in 2009 as well as the first robotic cystectomy (removal of the bladder) and several other oncologic and reconstructive procedures within the past year. Last year USO's robotic surgical experience was number one in Oklahoma. USO physicians perform typically 10-13 robotic surgeries each week.
Robotic surgery at USO is performed using the da Vinci Surgical System, a technologically advanced system that utilizes robotic instruments introduced via tiny incisions or laparoscopic ports. These instruments are under the direct control of the surgeon and are incredibly precise, offering more control and range of motion than standard instruments. Additionally, the specialized telescope of the robot allows the surgeon to see the operative field under 12X magnification and in three dimensions - as opposed to the standard two dimensional view (like television) that standard laparoscopy offers - providing greater visual detail than ever before possible.

Robotic Prostatectomy
Robotic prostatectomy or robotic-assisted laparoscopic prostatectomy is the complete surgical removal of the prostate gland and seminal vesicles. The procedure is performed laparoscopically using the da Vinci Surgical System. The da Vinci Surgical System provides the surgeon with better vision and better 'hands' through the use of advanced optics and computer and robotic technology.

How Is a Robotic Prostatectomy Performed?
The procedure is begun by inflating the abdomen with carbon dioxide gas in order to provide the surgeon with "working room". Next, six small incisions, 1/4 to 1/2 inch in length, are made in the abdomen and plastic or metal ports are installed to keep the incisions open. Seated at the da Vinci System console nearby and using both the laparoscopic surgical instruments and a pencil-sized video camera, the surgeon directs the da Vinci's robotic arms to dissect the prostate gland and adjacent tissue. The video camera's 12X magnification and 3D view enable the surgeon to identify the many delicate nerves, tiny blood vessels, and other structures surrounding the prostate gland. Once the procedure is completed and the prostate is removed, the patient awakens, is ambulating later that day and typically is discharged within 24 hours.

What Advantages Does Robotic Prostatectomy Offer?
Robotic prostatectomy, which has been shown to be as effective as conventional procedures in treating localized prostate cancer, offers these advantages:

Patient Benefits
For qualified candidates, the robotic prostatectomy offers numerous potential benefits over the traditional open prostatectomy, including:

• Shorter hospital stay
• Less post-operative pain and pain medication
• Less anesthesia
• Less blood loss and transfusions
• No blood donation necessary from patient
• Less scarring
• Fewer postoperative complications than open surgery including fewer post operative infections
• Faster and more complete recovery of our patients, 97% go home the morning after surgery. By comparison, time in the hospital for patients treated with open radical prostatectomy is two to four days
• Quicker return to normal daily activities
• Most patients return to work two to three weeks after the procedure and resume exercising or golf in 3-4 weeks, recovery time for patients treated with radical open prostatectomy is six to eight weeks.
• The catheter that drains the bladder is removed after seven days in robotic surgeries. In open radical prostatectomies, the catheter is removed after two to three weeks
• Covered by almost all insurance
• Costs the same as traditional open surgery

Surgeon Benefits
The da Vinci© Surgical System used at USMD Hospital for robotic prostatectomy extends the surgeon's capabilities to provide these significant benefits:

• 3-D Visualization: Provides the surgeon with a true 3-dimensional view of the operating field. This direct and natural hand-eye instrument alignment is similar to open surgery with "all-around" vision and the ability to zoom-in and zoom-out.
• Dexterity: Provides the surgeon with instinctive operative controls that make complex minimally invasive surgery procedures feel more like open surgery than laparoscopic surgery.
• Surgical Precision: Permits the surgeon to move instruments with such accuracy that the current definition of surgical precision is exceeded.
• Access: Surgeon perform complex surgical maneuvers through 9-mm ports, eliminating the need for large traumatic incisions.
• Range of Motion: EndoWrist© Instruments restore full range of motion and ability to rotate instruments more than 360 degrees through tiny incisions.
• Reproducibility: Enhances the surgeon's ability to repetitively perform technically precise maneuvers such as endoscopic suturing and dissection.

What Are the Side Effects of Robotic Prostatectomy?
The side effects associated with robotic prostatectomy, which are similar to those associated with open radical prostatectomy, include:

• Urinary incontinence
• Stress incontinence is the term given to the leakage of urine that can occurs when a patient coughs, sneezes, or lifts a heavy object after the procedure. All patients wear urinary pads after the procedure; 70% of patients are able to discontinue the pads by three months; 85% by six months; and 95% by one year.
• Erectile dysfunction
• Recovery of erectile function is dependent upon the pre-operative state of each patient. However, a nerve-sparing procedure can be performed better with "the robot" than with the open radical prostatectomy. Because of the precision and gentleness of the robotic prostatectomy procedure, these side effects are less common than they are with open radical prostatectomy. Patients also recover from the robotic procedure in a shorter time than from the open radical procedure.