Many of us are old enough to remember the 1965 Lost in Space TV programs in which the Robinson family was constantly alerted to threats by their robot. That android was really crude compared to its successors in Star Wars and even more so when you consider what robotics technology is capable of today – in real life.

One of the latest and most welcome developments in robotics is the treatment of prostate cancer with the da Vinci® Surgical Robotic System. Prostate cancer is quite common and it is said that most mean will die with prostate cancer even if they don’t die of it. St. Vincent Mercy medical Center is the first and only hospital in Northwest Ohio with the new technology and only the third hospital in Ohio to perform surgical procedures with the da Vinci® system.

Conventional treatment for prostate cancer includes:

• Watchful waiting or closely monitoring a patient’s condition without giving any treatment until appearance of change. This approach is usually taken in older men with other medical problems and early-cancer.
• TRUP (transurethral resection of the prostate) removes issue using a thin, lighted tube inserted through the urethra to relieve symptoms before other cancer treatment is begun.
• Radiation therapy uses high-energy or other types of radiation to kill cancer cells. External radiation therapy uses a machine to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer. Men treated with radiation therapy may experience impotence and urinary problems.
• Hormone therapy removes or blocks the action of hormones that can cause certain cancers to grow. Men who receive hormone therapy may experience, like women undergoing menopause, impaired sexual function, loss of desire for sex, and weakened bones.
• Surgery for patients younger than 70 and in otherwise good health may include radical prostatectomy to remove the prostate, surrounding tissue, and nearby lymph nodes. It involves an eight-to-ten inch incision and several days in the hospital. Men who have radical prostatectomy may experience impotence and incontinence.

Linda Grau, RN, a team leader in urology at St. Vincent’s, says “We encourage patients to choose da Vinci® because it reduces the risk of damage from open surgery where repair of the urethra is necessary. There is a better chance of sparing nerves and better repair of the urethra so the risk of incontinence is reduced as is the risk for impotence . In addition, the blood loss is reduced from about 1,000 cc in open surgery to about 100 cc with da Vinci®. The hospital stay is also cut in half – from four days to two days.”

Grau tells of a 48-year-old patient who came for a da Vinci® prostatectomy after he had visited Drs. Emmett Boyle and Michael Rashid. “We have been seeing patients in their 50s,” she says, “which is scary. In the 40s is very scary. That’s extremely young and there was no family history of prostate cancer. He was offered all of the standard options but he had done some research on the Internet and decided on da Vinci®. He said it appeared to offer less trauma and less risk of incontinence and impotence. He also liked the idea of four small incisions rather than the open surgery.”

The da Vinci® prostatectomy is a minimally invasive procedure performed robotically by a skilled surgeon from across the room. “Rather than a ten-inch incision,” says Grau, “The surgeon works through four small port holes, the longest of which is abut two inches. A camera is inserted into one, and the surgeon sits at a console where he has a true-to-life three-dimensional computer image. It is magnified ten times for better viewing of the process while the surgeon uses robotic arms to manipulate miniature surgical instruments through the other ports. Each instrument has a specific surgical purpose – clamping, suturing, or tissue manipulation, for example. They are equipped with quick release levers so instrument changes can be made easily by the surgical team during the operation.”

The robotic arms translate the surgeon’s hand and wrist actions into precise, scaled movements. The smaller incisions result in less discomfort and stress fro the patient, decreased risk of infection, a quicker recovery, and a return to work sooner than would be possible otherwise. For mot men though, it seems likely that the chief benefits are the reduced risk of incontinence and impotence.

Two month after his surgery, Grau says he still reports a little abdominal soreness but no leakage from incontinence. “He feels he did well,” she says, “because he was determined to follow instructions. Compliance is very important. The nurses came in after the surgery to say “Tonight you get up, tomorrow you walk.” He said there was tenderness at first but each time he got up his comfort level increased. He told us, “You can’t be a wimp about it!”

In 1965, using robots to perform complex and delicate surgery seemed futuristic fantasy but about 36,600 robotic procedures will be performed this year. In addition to prostatectomies, there will be heart-bypass surgeries, kidney transplants, hysterectomies and many other kinds of surgery. In May 2001, robotic surgery was approved for prostate surgery but was used in less than 1% of all prostatectomies. In 2005, more than 20% were done with the robot. The number of robotic surgeries is expected to double in 2006. For men facing prostate surgery, that is just one more reason to shout Happy New Year?