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Prostate Problem Guide
Robotic Prostate Surgery
Robotic prostate surgery is still very much in its infancy having only gained FDA approval in 2001 but, along with other forms of robotic surgery, is growing rapidly.
The first company to enter the field of robotic surgery was Computer Motion in 1989 who released the Aesop™ robotic system at the end of 1993. This was not terribly successful however as it was controlled using foot pedals and, although these were very effective, it was extremely difficult for surgeons to use to operate the pedals.
In 1996 a voice controlled system known as the Aesop 2000 was released and this was followed 2 years later by the Aesop 3000. In no time at all literally thousands of operations were being performed using Aesop robotic systems.
At about the same time Intuitive Surgical entered the field and proved to be a strong competitor using technology developed at the Stanford Research Institute and with strong collaborative partners such as IBM, MIT, Olympus Optical, Johnson & Johnson and others.
Intuitive Surgical developed the da Vinci® Surgical system, which received FDA approval in 1997, and by mid 2000 had developed the world's first laparoscopic robotic surgical system. A hand controlled system incorporating a unique 3D vision system, the da Vinci Surgical system soon took the lead in robotic surgery but quickly became embroiled in a legal battle with Computer Motion over patent infringements.
After a lengthy battle things were finally resolved when Intuitive Surgical acquired Computer Motion in 2003 leaving them today as the world's foremost supplier of robotic surgery equipment.
The da Vinci® Surgical system consists of 4 main components:
1. The surgeon's console.
The surgeon sits at a console which is placed to one side of the operating theatre and from here he views the operation site through a specially designed 3D viewing system.
The instruments which are used to perform the surgery are then hand operated with an extremely high degree of precision by remote control through the surgeon's console.
2. The patient-side cart.
The patient-side cart is essentially the 'robot' which stands beside the operating table and consists of a variable number of interchangeable operating arms which are used to carry the instruments required for the particular operation, as well as an endoscope arm to enable the surgeon to view the site of the operation.
An assistant stands by the patient-side cart and can change the instruments needed as required.
3. Detachable instruments.
In many ways it is the advance in instrument technology that have made robotic surgery possible and today and the range of instruments available and the degree of manipulation possible with these instruments is truly a technological marvel.
The Endowrist instruments, all of which are detachable, can be changed quickly and easily using quick-release levers and allow the surgeon to carry out the most delicate of surgery with a very high degree of precision.
4. 3D vision system.
The 3D vision system used by the da Vinci® Surgical system provides enhanced 3D images of the operation site with real-time high resolution magnification.
This vision system provides the surgeon with an excellent view of the operation site which is far superior to that seen even in open surgery
Combined with the high degree of precision in manipulation possible for the robotic arms and instruments, the surgeon can carry out even the most delicate of surgery.
Additional Reading:
A Revolutionary Prostate Operation
Robotic Prostate Surgery - The da Vinci System
5AR: 5 alpha reductase; the enzyme that converts testosterone to dihydrotestosterone (DHT).
GLEASON: name of physician who developed the Gleason grading system commonly used to grade prostate cancer.
INSULIN GROWTH FACTOR 1 (IGF-1): a growth factor that stimulates prostate cancer cell growth and osteoblast growth.
STAGING: the process of determining extent of disease in a specific patient in light of all available information; it is used to help determine appropriate therapy; there are two staging methods - the Whitmore-Jewett staging classification (1956) and the more detailed TNM (tumor, nodes, metastases) classification (1992) of the American Joint Committee on Cancer and the International Union Against Cancer. Staging should be subcategorized as clinical staging and pathologic staging. Pathologic stage usually relates to what is found at the time of surgery. The TNM system is now most commonly used. Whitmore-Jewett Stage A becomes TNM T1 Stage B becomes T2 Stage C becomes T3.
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