Robot-Surgeon Scrubs in at DeBakey VA for Urological Surgery
HOUSTON - The Michael E. DeBakey VA Medical Center (MEDVAMC) recently initiated clinical use of the da Vinci®, a surgical robotic system to perform minimally invasive urological operations, including the removal of cancerous prostate glands.
According to the Prostate Cancer Foundation, prostate cancer is the most common non-skin cancer in America. In 2006, over 232,000 men will be diagnosed with prostate cancer, and over 30,000 men will die from it. One new case occurs every 2.5 minutes and a man dies from prostate cancer every 17 minutes.
“Adding robotics to our vast range of advanced surgical capabilities dramatically expands our ability to perform minimally invasive techniques,” said David H. Berger, M.D., MEDVAMC Operative Care Line executive. “Robotics allow us to perform complex procedures endoscopically, through tiny ports of access, which means our patients have less physical trauma, less blood loss, less pain, and a more cosmetically-pleasing outcome compared to open surgery.”
Seated at the system’s master console 10 feet away from a patient, a surgeon moves the surgical instruments inside the access ports through ergonomic hand and foot controls. Each of the surgeon’s hand, wrist, or finger movements is seamlessly translated by the robotic surgical system into corresponding micro-movements of the surgical instruments, which are held steady by the system’s robotic arms. The robotic system provides so-called “intuitive motion” so that in whichever direction the surgeon twists the controls, the instruments twist in the same direction. In standard laparoscopic surgery, the movement of the instruments is reversed – or similar to doing surgery while looking into a mirror.
“Because the prostate is situated low in the pelvis, it can be difficult to view the area up close and reach it through non-invasive means,” said Donald Griffith, M.D., chief, MEDVAMC Urology Section. “With this new system, we can view the area with the navigational camera in a magnified, high-resolution, 3-D view and only need to make a few tiny, one centimeter access ports to do so.”
In 2007, the MEDVAMC received notification from the National Veterans Affairs Surgical Quality Improvement Program Executive Committee that it had demonstrated consistently low observed-to-expected mortality rates in general surgery, all surgery, and all non-cardiac surgery seven years in a row. The MEDVAMC is the only VA facility with this record.
“Robotic surgery for prostate cancer is not appropriate for all patients or for all prostate glands. Prostates, cancers, and pelvic anatomy differ from patient to patient. At the Michael E. DeBakey VA Medical Center, we recommend the treatment that is most appropriate for the patient and his particular medical condition,” said Griffith.
In the future, the MEDVAMC plans to expand use of robotic surgery techniques into the areas of cardiac, thoracic, gynecological, and oncology procedures. The MEDVAMC already uses innovative, minimally invasive techniques to treat such medical conditions as atrial fibrillation, spinal fractures due to osteoporosis, and heart valve surgery.
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