Expert Commentary: David L. Zumerchik, M.D. - 03/22/2010

Posted by Admin on March 22, 2010
I have been using the DaVinci robotic system for the last 5 years. The use of robotic systems in surgery has greatly improved our patient's recovery, both in speed to recovery and reduction of pain. Previously, most abdominal surgeries required open incisions in the abdominal wall. Such surgical procedures required weeks of recovery and greatly increased the risks of potential complications. Procedures that required the removal of delicate tissues, such as surgical treatment for prostate cancer, were often imprecise in the amount of tissue removed.

With the advent of Laparoscopic treatment, and other non-invasive surgical techniques, we have not only reduced complication rates, but dramatically reduced patients’ recovery. For many procedures, patients now go home the very same day, which in the past would have required several days in the hospital. 

The next phase in the development of non-invasive treatments has been the development of robotic surgical aids. The physician uses 3D imaging and finely controlled tools that allow a surgical precision that heretofore simply was not possible.

For example, robotic surgery is revolutionizing how prostate surgery is conducted.. Nerve fibers and blood vessels are attached to the prostate gland. To spare these nerves, they must be delicately and precisely separated from the prostate before its removal. Surgeons use the precision, vision and control provided by the robotic system to assist them in removal of the cancerous prostate while preserving important nerves and blood vessels.

The great concern for prostate cancer patients is urinary continence and sexual function after treatment. We have seen patients who undergo a robotic system assisted

Prostatectomy may experience a faster return of urinary continence following surgery and a lower rates of urinary pain than radiation patients. It is also important to protect specific nerves to assure the ability to achieve an erection post-surgery.

Several studies also show that patients who are potent prior to surgery have experienced a high level of recovery of sexual function (defined as an erection for intercourse) within a year following this form of surgery.

It is important to know that this kind of surgery does not place a robot at the controls; the surgeon is always in control of every aspect of the surgery. What it does do is give the surgeon great visualization in 3-D which allows for very accurate and precise suture placement.

The only drawback, if any, is longer time in the operating theater.  However, taking the extra time is well worth the outcome – speedier and more effective recovery.

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