St. Vincent da Vinci Surgical System

Randy Tidwell, 55, lost his mother to liver cancer and his father to pancreatic cancer both in 2007. So when he was diagnosed with prostate cancer in February 2011, it was a big concern.

“I have four children and four grandchildren to live for and spend time with,” Tidwell said. 

After a biopsy and diagnosis of cancer in Hot Springs, he found out the surgeon there did “old school” surgery for prostate cancer. Tidwell opted instead for robotic surgery done by Timothy D. Langford, MD, at Baptist Health Medical Center in Little Rock.

“I chose robotics because it seemed to be less invasive, less blood lost, no large incisions and the research I did said that it was just better,” Tidwell said. “I was told that the surgical procedure would be better than radiation, since it can pinpoint the actual area, whereas radiation can damage surrounding tissue.”

Seven weeks after surgery, Tidwell was feeling good and hadn’t had any incontinence—a potential side effect of prostate surgery—for a month. He feels like he is “way ahead of the curve.”

“The best thing is to not have cancer to deal with at all, but this procedure is the next best thing,” Tidwell said. “I am very much an advocate of this procedure. “

Langford, who practices with Arkansas Urology, said about 84 percent of all prostatectomies in the U.S. are now done with the da Vinci Surgical System.

“The main advantages of robotic surgery are the camera, which allows the surgeon to view the surgical field in three dimensions and high definition, the wristed instruments which allow more precise surgery, and it provides a pathway to use new technologies such as fluorescence imaging,” Langford said. “The newest technology is fluorescence imaging which gives the surgeon more confidence in performing a partial nephrectomy. This enhanced imaging system allows the surgeon to better differentiate the tumor from normal renal tissue. This allows the procedure to be done in a way to spare as much renal tissue as possible and also to increase the possibility of having a good negative margin.”

Surgeons performing robotic surgery have undergone intense training to obtain the necessary skills and experience. The first step is online modules and simulation training. There are da Vinci practice sessions to develop the specific skill sets needed.

“This is usually followed by performing procedures in a live porcine lab,” Langford said. “The surgeon will then normally observe live cases by an experienced surgeon. He or she will then perform their own cases which are proctored by an experienced da Vinci surgeon. If a surgeon wants to acquire further skills, advanced training courses are available which usually include hands-on animal labs.”

Langford said cutting-edge technologies, such as robotic surgery, are essential in Arkansas. The technological advances – 3D imaging, small wristed instruments controlled by the surgeon using a console and computer technology – have allowed urological surgeons to perform such procedures as radical prostatectomy, partial nephrectomy, radical nephrectomy, dismembered pyeloplasty, vesicovaginal fistula, and other reconstructive procedures in a more precise manner and minimally invasive way resulting in improved patient care.

“Use of the technology has expanded into the area of gynecology, general surgery, and cardiac surgery,” Langford said. “Robotic surgery will serve as a platform for many advanced technologies in the future which have and are being developed. As patients are becoming more sophisticated, they are researching their surgical options and actually demanding that robotic surgery be available to them.”

Urologist Keith Mooney, MD, with Arkansas Urology, performs da Vinci surgeries at both Baptist Health and St. Vincent Health System. He has been doing the surgeries since 2005 operating on 800 patients robotically.

“The patients are pleased,” Mooney said. “It helps them convalesce from surgery faster, there is less post op discomfort, less bleeding, and some of the issues of incontinence and impotency have improved. The optics with the robotic da Vinci system allow you to see much better around the prostate, which allows you to do more meticulous dissections around blood vessels and nerves for erection.”

Using small keyhole incisions and shorter stays in the hospital have significantly reduced infection rates. The robotic surgery also has advantages for kidney surgeries.

“We also are now doing nephron-sparing procedures where we remove parts of the kidney with a tumor associated with it,” Mooney said. “It seems the human body likes to have two kidneys and this has turned out to be a nice adjunct in our kidney cancer armamentarium. Having two kidneys appears to reduce cardiovascular disease later. We do total nephrectomy and nephroureterectomy, as well.”

Robotic surgery is rapidly spreading among all surgical specialties, said Mohamed H. Kamel, MD, an assistant professor of urology, a urologic oncologist, and a robotic and laparoscopic surgeon at the University of Arkansas for Medical Sciences (UAMS). In addition to using the robot to remove kidney cancer without removing the whole kidney, which can be done in a large number of patients, there are other applications.

“At UAMS we have performed the first robotic excision of retroperitoneal lymph node metastasis in a young patient with testicular cancer in the state of Arkansas,” Kamel said.

Because of the increasing acceptance of new robotic surgery technology, the urology department at UAMS has incorporated robotic surgery training to all their residents.
“Robotic surgery is now the way forward,” Kamel said. “Having this technology in Arkansas means that our patients derive immense benefits of new cutting edge technology.”

The usual big cost of robotic surgery is at the beginning when hospitals are purchasing the equipment. There is additional cost than regular surgery, about $1,200 per case. But Kamel said this is offset by the patient's shorter hospital stay, lesser pain medication requirements and faster return to work. There are also lower operating room costs because of the decreased time needed for surgery.

“We believe that the capital expenses will drop in the future when the technology is more adopted and possibly when other companies get involved in the competition of making surgical robots,” Kamel said.

Tags:

Bookmark:

Facebook

Technorati

Newsvine

Google

Related: