Leading the treatment of prostate cancer
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Leading the treatment of prostate cancer
Galway Clinic
da Vinci Robotic Surgery System
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What is the prostate?
Male sexual gland Adds nutrients and
fluids for sperm This fluid is added
to sperm during ejaculation
Urethra (urine channel) runs through the middle of the prostate
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Prostate Cancer
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What is prostate cancer?
Abnormal cells growing out of control Spreads and invades local tissues Prostate Cancer
Begins with a small tumor in the gland First spreads to the local lymph nodes Then spreads to the bony skeleton and other
areas of the body
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Prostate Cancer Facts
Prostate cancer 543 prostate cancer deaths in Ireland in 2002 Leading type of cancer in men 2nd most common cancer killer of men Estimated 15,000 men living with prostate cancer Projected increase of 270% over the next 12
years Note: 400 Road Deaths in Ireland in 2005
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Early Detection
Early Detection Best prognosis is early detection Recent data on lower mortality rates of prostate
cancer Affords patients many options for treatment
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Early Detection
Digital Rectal exam (DRE)
Prostate Specific Antigen blood test (PSA)
Any abnormality in the PSA or DRE will require Biopsy of the prostate Ultrasound guided Usually performed in
the office Short procedure
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Biopsy results
Prostate cancer graded on appearance of cancer cells
Gleason grading system Gleason grade ranges
from 1 (least aggressive) to 5 (most aggressive)
Gleason score (2-10) Most common cell grade
(first) added to second most common cell grade
i.e Gleason 7 (3+4)
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Staging of Prostate Cancer
PSA Digital Rectal Exam Trans Rectal Ultrasound Gleason Score Bone Scan +/- CT scan or MRI Biopsy and TNM staging system
Tumor, Nodes, Metastases
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Prostate Cancer T1 disease
Cannot be felt T1a – cancer found in
≤ 5% TURP specimen T1b - cancer found in
≥ 5% TURP specimen T1c – cancer found as
a result of PSA elevation only
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Can be felt during DRE (digital rectal exam)
T2a – felt on one side of prostate
T2b – felt on both sides of prostate
Prostate Cancer T2
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Has spread beyond the prostate
T3a – extra capsular extension
T3b – tumor invades seminal vesicle(s)
Prostate Cancer T3
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Cancer has invaded local organs
Bladder invasion Invasion into
surrounding pelvic side wall
May cause pain in joints and back
Prostate Cancer T4
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Treatment Options
Dependent upon……
Stage of disease Patient’s age and health Patient’s personal preference
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Treatment Options
Radiotherapy Brachytherapy Surgery
Open Radical Prostatectomy Laparoscopic Radical Prostatectomy Robotic Assisted Radical Prostatectomy
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Goals of Radical Prostatectomy
Remove the prostate and cancer High cure rates for localized disease Preserve urinary function Preserve erectile function Analyze the prostate after surgery to assess
risk of recurrence of cancer
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Laparoscopic Surgery
Minimally invasive surgery
Ability to operate through small keyhole incisions
Camera and instruments fit through the keyhole incisions
Better visualization than open surgery
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Conventional Laparoscopic Surgery
Drawbacks
2–D flat image video Rigid instruments - chopsticks Instruments controlled at a distance - fulcrum
effect Decreases your surgeon’s precision, dexterity
and control Higher surgeon fatigue Makes complex operations more difficult
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How can we overcome these drawbacks?
Provide a high resolution 3–D color image Interpose a computer between the surgeon’s hand and
the instrument tip Increase the surgeon’s dexterity for the difficult
aspects of the procedure Sparing the nerves to preserve erectile function Preserving continence Preserving quality of life
Robotic Assisted Surgery System
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Main Intellectual Drivers of Robotic
Surgery
Department of Defence NASA MIT Stanford University
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History of Robotic Prostatectomy
1980’s master slave remote operating developed by NASA and US military
Patents held by 3 competing companies 1999 merger with Intuitive Surgical,CA USA sole ownership Device is ‘Da Vinci’ Robotic Surgical
System 2001 FDA approval for use on humans
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What is the da Vinci® Robotic Surgical
System? Powered by state-of-
the-art robotic technology
Surgeon is in control and operates at the console
Assistant surgeon is next to the patient
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Surgeon is immersed in 3-Dimensional image of the surgical field
Vision System
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The surgeon’s hands are placed in special devices called masters that direct the precise instrument movements
Instruments move like a human wrist unlike traditional laparoscopic instruments
Instruments are small and are able to fit through keyhole incisions
The Surgeon Directs The Instruments
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Advantages to the Surgeon
Access ROM- 8 degrees 3D binocular
vision X10 magnification Pneumoperitoneu
m Tremor filter Ergonomically
intuitive Benefits of MIS
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Advantages to the patient
Minimally invasive ‘keyhole’ surgery Less blood loss Shorter hospital stay Decreased postoperative pain Less scarring Faster return to normal activity Earlier return to urinary continence Earlier and improved rates of erection Better cosmesis
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Comparison of Open Surgery and Robotic- Assisted Procedure
Open Procedure Long Incisions Hospital Stay of 5-7 days Blood Loss 900ml Catheter removal 14 to 21 days
Robotic-Assisted Procedure 5 or 6 small keyhole incisions Hospital stay of 2-3 days Blood Loss 153 ml Catheter days 5 to 7 days
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Robotic-Assisted Surgery Access
Open Surgical Incision Robot Assisted Prostatectomy Incision
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Worldwide applications of Da Vinci Robotic
Surgical System
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da Vinci® Surgical System U.S. Installed Base 1999 – 2006
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da Vinci® European Installed Base 1999 –
2006
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UK Experience
Imperial College Six centres including Cambridge
University Averaging 3.8 procedures per week
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Galway Clinic, Ireland Consultant Urologists Drs. David Bouchier Hayes and
Paddy O’Malley have proven track record in performing this surgery in leading Australian centre of excellence.
Da Vinci Robot purchased by Galway Clinic in July 2007
Capital costs of €2.7 million provided by investors and members of the board of Galway Clinic
VIVAS, VHI & QUINN all cover this procedure. First robotic assisted prostatectomy in Irelandwas
performed in November 07.
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Other Roles for Robot Assisted
Surgery
Cardiac Surgery Mitral Valve Repair Single Vessel Bypass Graft
Anti-Obesity Surgery Thoracic Surgery
Partial lung removal for cancer