The da Vinci Works

We were sitting around the table, and the air was thick. No one was speaking. My two sisters and I glanced back and forth, unaware of what was going on.  A family meeting? In my twenty-one years of life, I have never heard that phrase in my household.

What could be going on?  My mother walked in with her eyes puffy and red, giving off the impression of defeat. She is a strong, independent lady, so seeing her this way made my heart ache. My dad followed behind her, slowly walking into the kitchen. He tried to act confident, but we all could see his sorrow. We never have times like this in our house. My dad spoke, “Cancer.” My heart dropped and the breath shot right out of me. I have never imagined that word describing anyone in my family. Sitting there, in shock, we were not sure what to do. Tears began to run down all our faces.

Cancer.

My dad had seen his doctor for routine checkups, like every man is supposed to do as they reach a certain age. During one of his checkups, his doctor noticed that he had an enlarged prostate. This is something common among men as they get older that usually settles down with some medication.  He took the medication, but nothing happened.  “I didn’t know how this could be,” my dad said. “I have been dieting, trying to work out more and taking my medication regularly, and each checkup was the same thing. This is the point where I started getting worried about what was going on.”

Finally, the dreaded day had come; he had to go in for a biopsy. My dad admitted, “Getting a biopsy of my prostate was one of the most nerve-racking experiences I have ever had to go through. I can not put into words what was going through my mind or how I felt during this process. It was just dreadful.” In the long run, getting the biopsy was not the most difficult part. The wait for the result was unbearable, just hanging around for the phone to ring, hoping for good news.

What to do next? How to proceed to fix this so that it does not spread and does not end up incurable? According to the Prostate Cancer Foundation, prostate cancer is the most common cancer diagnosed in men in this country and the second leading cause of cancer-related deaths.  The prostate is a gland the shape of a walnut in the male reproductive system, and this type of cancer develops most frequently in men over fifty.  Generally, it is a slow growing and a moderately aggressive cancer.  Older men, in their seventies, for example, are often not treated for this condition, as they are likely to die from other health issues before the prostate cancer kills them. 

If detected early, the cancer will often be contained in the prostate, and treatment can result in a high likelihood of a complete recovery.  According to the National Cancer Institute, there are four main types of treatment: surgical treatment, radiation treatment, cryotherapy and hormone therapy. The stage of the cancer and the general health of the patient help determine what treatment procedure would be most effective.

If the patient is in his fifties or early sixties and in good health, surgery is usually recommended, as you can always use radiation and other treatments as follow up procedures. As an initial treatment radiation can make surgery in the future difficult because of all the scar tissue that results from the procedure.   Historically, traditional open surgery was performed to remove the prostate.  The surgeon would use one of two accepted procedures, a radical retropubic or radical perineal prostatectomy, to make a long incision and remove the prostate. 

The laparoscopic radical prostatectomy was developed as an alternative to open surgery.  Similar to having a knee scoped, several small incisions are made, a small video camera that provides excellent lighting is inserted so the surgeon can see, and other long instruments are used to remove the prostate.  The benefits compared to open surgery include: less blood loss and pain, a shorter hospital stay and a faster recovery.

My dad’s primary doctor recommended open surgery.  For a second opinion, he met with Dr. Roehrborn, who is the Head of the Urology department at UT Southwest Medical Center.  He is one of the few surgeons in Dallas-Fort Worth taking the laparoscopic procedure to the next level by utilizing a robotic surgical technique.  Dr. Roehrborn said, “The da Vinci Prostatectomy is essentially a robotic surgery for prostate cancer. Since the cancer was caught early in [my] dad’s case, we are able to use this type of treatment, extract the prostate, and hope for a full recovery without any long term side effects from the procedure.”

The da Vinci robotic system, introduced in 2000, is a very expensive robotic interface.  In the DFW area, it is currently available only at UTSW and a hospital in Arlington.  The benefit of the robotic system is more maneuverability and precision using the instruments compared to the standard laparoscopic procedure.   According to Dr. Roehrborn, three pieces of eqiptment make up the da Vinci system: the Ergonomic surgeon’s console, a patient side cart with interactive four robotic arms, and a high definition 3D vision system.  

The 3D magnification screen provides the surgeon with high resolution clarity.  The robotic surgical arms used today are one centimeter in diameter and more maneuverable than the original much larger arms.  This allows for highly precise movements within a very small operating space.  It also results in very little bleeding, sometimes as low as 50 cc’s.  Less bleeding means a more stable process and less need for transfusions.  Also, the chance of allergic reactions, infections, anemia, fatigue and heart complications are greatly reduced.  There is also very little pain due to the less surgically invasive approach. Dr. Roehrbron says, “In comparison to the invasive, surgical extractions I have done in the past, I have come to the conclusion that there is less blood loss, less scarring, less pain, and a faster return to everyday life when using the da Vinci surgery method. Instead of the typical and more powerful pain medications, the only pills patients need after surgery is a couple of Tylenol.  It is a very different experience when you use the da Vinci system.”  

In the operating room the doctor is seated at the console and the screen shows a clear 3D image of the patient’s surgical field.  The console is a few feet away from the patient, which reduces the chance of infection since the doctor is so far away.  The doctor straps his or her fingers and hands into the machine, and any movements he or she makes are transmitted to the robotic arms that are located over the patient.  The main advantage of this approach is that the arms can freeze the instruments in their current position, and they can be rotated in any direction.  If the surgeon is using his or her hands, either in open surgery or laparoscopic surgery, he or she must pull back on the instruments before moving in a different direction.  This gives the surgeon technology to improve surgical procedures and can provide better results for the patient. 

In the end, the skill of the surgeon is still the critical factor.  This technology will not make up for an unskilled surgeon.  Using the da Vinci procedure gives surgeons a better view because the da Vinci system magnifies the surgical field.  The magnification capability is up to ten times the normal view.  This is significant when compared to the vision offered in open surgery.   With better vision and interactive robotic arms, doctors are able to perform less invasive surgeries for more complicated procedures.

Robotic surgery is currently being performed in a number of areas such as urological, general non-cardiovascular thoracosopic surgeries, and general laparoscopic surgery for both pediatric and adult procedures.  The European medical community, particularly Germany, has really embraced the concept of robotic surgery.  Clinical tests are being performed in hospitals all over Germany. An area of interest is in orthopedic surgery and joint replacements. The future of this procedure is very promising as well, since its use will only be limited by the imagination of the surgical community.

My dad believed the da Vinci surgery would be the best option for him. He did not want to have to go through radiation or hormone therapy that would cause unwanted side effects. Like any person, he also wanted a treatment that would have the fastest recovery with the most effective procedure. My dad is still young and believes that he has the ability to overcome this obstacle in his life and move forward. My dad never thought that he was going to be in this situation, he did not have any family members who had prostate cancer, so this came as a surprise to him. With the new system and advancing technology, diseases we never thought could be cured are being treated.

My dad had put so much faith into the four robotic-armed surgery, which would help cure his cancer; he waited patiently for his time to undergo the treatment. With the thought of never having to look back and worry about this, my dad is optimistic about this new da Vinci system, and the future it has. He believes that, “one day, any surgery we go in for, they are going to be performed with the da Vinci system.” Can you imagine robots working on you?