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The future of prostate surgery: robotics

I’ve seen the future of prostate surgery and it works robotically

Published in The Times, 10.11.2006, by Prostate Centre patient Dr Thomas Stuttaford

The Victoria and Albert Museum in London has an exhibition of the drawings, manuscripts and models of Leonardo da Vinci, the Italian artist and inventor, now on show. Da Vinci drew a flying machine more than 400 years before the Wright brothers took to the air. He also studied the anatomy of the human body and his anatomical pictures have never been surpassed, even though he left out the prostate: one organ that is essential for the continuation of the human race.

Da Vinci may have spurned the prostate gland but his surname will be for ever linked with it. The robot that has been introduced to assist surgeons when performing a radical removal of a cancerous prostate gland is called da Vinci. One of the five robots in the UK is at the London Clinic. It has proved so successful that Professor Roger Kirby and his anaesthetist now do most of the radical prostatectomies using a robot rather than hands-on open surgery. Kirby is doing his 100th robot-assisted prostatectomy this week.

As always in medicine, when any new procedure is introduced the learning curve is a steep one. Kirby and his team went to the US, where they were taught at the Henry Ford Hospital, Detroit. After the British team returned to the UK it brought with it an American teaching delegation that supervised its early efforts.

So skilled has Kirby become at doing them that when I was watching his 95th robotic prostatectomy this week his patient, as it happens an American, was on the operating table for only a couple of hours and Kirby’s robotic cutting, dissecting and stitching was over in 1 hour and 45 minutes.

The image the term conjures up is that of a child’s Dalek that swoops across the sitting-room floor cleverly avoiding obstacles, or even of an automated housemaid. The da Vinci robot is nothing of the sort. It is a million pound plus bit of kit that helps to make this minimally invasive surgery safer than standard open prostatectomy. The hands-on team sit with the patient in front of screens rather like a Star Trek Enterprise crew, and they help to work the arms of the robot and other instruments through small holes or ports.

Captain Kirk, alias Roger Kirby, is, as on Star Trek, stationed away from the main body of the skip but his is in control and directs every movement and gives a running commentary and orders from this console (a cabin in Trekkie language). The relationship between surgeon and robot is known as master and slave, Kirby being the master. The surgeon’s hands never enter the patient. When the robotic arms and the tiny camera are inside the body, he guides the robot’s work by inserting his fingers and thumbs into two stirrups that have mitten-like holes. Unlike endoscopy, Kirby is working in 3-d rather than 2-d.

Gordon Borrie, now Lord Borrie, the chairman of the Advertising Standards Authority, had the robotic operation carried out three weeks ago. He is already walking from his house to the office and the Lords. He feels well, had no pain after the surgery and supports all the claims made for its advantages.

During an open prostatectomy the complication rate is 15 per cent. With non-robotic prostatectomy there is a 10 per cent complication rate, and with the robotic-assisted one, the risk is 5 per cent. Blood loss is minimal. There is early evidence that using a robot long term doesn’t adversely affect the cure rate and that the incidence of both urinary incontinence and sexual impotence are probably reduced – exact statistics are not yet confirmed. However, hospital stays are halved and the postsurgical catheter comes out earlier, after eight days rather than 16.

Before Lord Borrie had is surgery I suggested that he might do as well with an open prostatectomy. I was wrong.

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