UPDATE - Issue 25 - Spring 2006
Rise of the Robot
by Prof Roger Kirby
Nerve-sparing radical retropubic prostatectomy is the only treatment for localised prostate cancer that has been proven to reduce the mortality of the disease. Although cancer control is good and persistent urinary incontinence unusual, many patients still complain of reduced or complete loss of erections, after this type of surgery.
The recent advent of the Da Vinci™ robot from Intuitive Robotics now seems set to remedy this problem. assisted radical prostatectomy involves access to the prostate via six 2cm incisions through which the robotically controlled instruments are introduced. The amount of blood lost during the procedure is much reduced, because the high pressure within the abdomen discourages bleeding. The 10x magnification and the enhanced 3-D visualisation helps us to see the nerves that lie close to the prostate and are important for sexual function. Moreover the reconstruction of the connection between the bladder and urethra can be performed with greater accuracy, enhancing the prospects for early return of complete continence. Patients can be mobilised earlier, discharged from hospital more quickly and may anticipate an earlier return to work and play.
Richard Dodd, a 65 year-old Director of Photography, was one of the first patients to undergo robotic surgery for prostate cancer. These were his thoughts: 'I felt very strongly that open surgery was not an option for me. There are significant benefits of robotic surgery which were very appealing to me, in particular the reduced risk of common side effects such as incontinence and impotence. My recovery since the operation has astounded me. While there have been moments of discomfort, I have not experienced any pain. I was able to work within two weeks, maintain a sensible fitness regime within three weeks and plan to live life to the full on the ski slopes in under three months!'
The only down-side of the robot is its cost. At around £1.5 million per machine and substantial running costs, it is not surprising that there are only a handful of them in the UK at present. St Mary's and Bart's and St Thomas's NHS Trusts were the first to acquire the technology; the Princess Grace Hospital and the London Clinic also have machines. St James's Hospital in Leeds is also commencing a robotic programme soo. By contrast there are 256 Da Vinci™ robots in action in the USA. For more information check out www.intuitiverobotics.com and watch out, the robots are on the rise!