June 2008

After David Nelligan was diagnosed with prostate cancer, he researched different treatment options. Then, PAMF urologist Daniel Yao told him about a new procedure he was performing -- robotic-assisted prostatectomy (prostate removal surgery) -- and Nelligan said the decision "was a no-brainer."

Robotic-assisted prostatectomy is a type of minimally invasive surgery for men with localized (not having spread to other organs) prostate cancer who need to have their prostate removed. Compared with traditional surgery and even some of the newer minimally invasive procedures, robotic-assisted surgery typically involves less blood loss and pain, lower risk of complications and side effects, shorter hospital stays and faster recovery times.

During the surgery, Dr. Yao sits at a console and looks into a binocular eyepiece lens system that provides a three-dimensional view of the patient’s vital organs and structures. The lens system offers up to 15 times greater magnification than the human eye, which means Dr. Yao can actually see the surgery site better than he could in a normal surgery.

The device’s sensitive hand controls allow Dr. Yao to perform precise surgery through incisions that would be too small for traditional procedures.

"Using robotics to perform surgery seems futuristic, but it is currently accepted technology and approved by the U.S. Food and Drug Administration. As a doctor, it helps me provide better care to my patients,” said Dr. Yao. “Although I use robotic technology, the system is entirely under my command and simply allows me to operate on my patients in a more accurate and precise way than I could on my own."

How? The robotic surgical system filters out normal hand movements and tremors that are common even among surgeons with the steadiest hands. The system’s “wristed” instruments mimic human hands and wrists, and provide 90 degrees of articulation and 7 degrees of freedom, allowing for greater range of motion than a human hand. All of these factors enable a more exact surgery.

Because the surgery can be performed using very small incisions, patients have less blood loss, which minimizes the need for blood transfusions, and a quicker healing process. In fact, many robotic prostatectomy patients are discharged from the hospital within a day of surgery, compared to two or three days with conventional surgery. They also return to their normal activities within two weeks, rather than six weeks as is typical with non-robotic prostate removal surgery.

For many men, the procedure is also a desirable alternative because it potentially minimizes side effects, such as incontinence and impotence. The robotic system’s fine articulating instruments allow Dr. Yao to carefully remove the prostate and preserve the nerves responsible for maintaining erectile function.

"My experience was just like I read about –- I went home after only one day in the hospital, had no pain, was walking two to three miles just a week after my surgery and didn’t have too much of a problem with side effects, like incontinence," said Nelligan. "I have no regrets about my decision to have surgery. I’ve had a really good experience."

"Most of my patients who have had robotic-assisted prostatectomies have really been pleased with the results and how quickly they’re able to recover and preserve the quality of life they had before prostate removal," said Dr. Yao. "This could be the future of surgery."