Robotic Prostate Surgery – A Unique Approach

When you think of “robotic surgery,” it is difficult not to imagine a C-3PO style robot standing over an anesthetized patient. While this may be your first thought when you hear robotic surgery, that type of scenario is a long way off for most surgical procedures. Fully autonomous robots performing surgery is still the stuff of science fiction rather than common medical practice. However, there is one type of robotic surgery that comes a bit closer to this fanciful image of futuristic surgery: robotic prostate surgery.

 

 

The most commonly used device for general robotic surgery is the da Vinci® Surgical System. This rather elaborate device is, at its heart, simply a set of robotic arms that are constantly under the control of a surgeon. The surgeon manipulates an advanced set of remote tools which guides robotic arms to perform the incisions, clamping and suturing of the surgery. Robotic prostate surgery puts far more control in the (computerized) mind of the robot. The robots used in prostate surgery are supervised and directed by the surgeon, to be sure, but in a much different way that more traditional robotic procedures.

 

Robotic prostate surgeries use a technique known as DIGI or direct image-guided intervention. Throughout the surgical procedure, the prostate is repeatedly imaged using CT or MRI technology and a three dimensional representation of the prostate is constructed from those images. With that graphical information, the robot can determine how to access the prostate and which areas of the prostate need to be removed.

 

The “real time” imaging and precision of the robot in prostate surgery confers several advantages to the patient. The feared consequences for patients undergoing prostate surgery are incontinence and impotence. Advancements in robot-assisted surgery are improving patient outcomes in these two important areas. The clinical experience and information is quite new as the techniques are still being developed, however, early indications are that in selected patients, robotic prostate surgery may decrease the occurrence of incontinence. Control of urination may return more quickly with robotic prostate surgery. The degree and completeness of cancer resection appears to be better as well (i.e. all of the cancer is removed and more of the healthy tissue is left intact). It also appears that sexual potency after robotic prostate surgery is similar to the rates found in more traditional prostate surgeries.

 

What is so compelling about robotic prostate surgery is that unlike other robotic-assisted surgeries, the surgeon gives the robot certain tasks to perform rather than directly controlling the robotic arms with a remote device. On the one hand, the surgeon relinquishes direct control (the surgeon can stop or intervene at any moment) yet, on the other hand, the robot only performs one of a certain number of predefined tasks. In terms of current robot-assisted surgical procedures, prostate surgical robotics are the closest to the vision of a robot performing surgery by itself. But, in reality, humans are still the master of the operation and no move is made unless predefined and permitted by the surgeon directly.