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The Da Vinci Robotic Surgery

03/2005, PSA Newsletter

Dr Peter Sutherland has recently given two talks about the Da Vinci Robot Surgery system he has been using for radical prostatectomies. The talks have been illustrated by very graphic video presentations, some preliminary information about the hardware, its history of development from a military need to the story of its establishment at the Royal Adelaide Hospital.

There is a lot of information on the system on the Web, complete with videos. One of the best sites is at http://www.davinciprostatectomy.com/ specializing in its application for prostatectomies.

Below are some words from the makers, Intuitive Surgical’s website (http://www.intusurg.com).

“The da Vinci® Surgical System is an integral part of the operating room and supports the entire surgical team. The System consists of a surgeon console, patient-side cart, instruments and image processing equipment.

• The Surgeon Console
  Using the da Vinci Surgical System, the surgeon operates while seated comfortably at a console viewing a 3-D image of the surgical field. The surgeon's fingers grasp the master controls below the display with hands and wrists naturally positioned relative to his or her eyes. Our technology seamlessly translates the surgeon's hand, wrist and finger movements into precise, real-time movements of our surgical instruments inside the patient.
• Patient-side Cart
  Provides the three or four robotic arms -- two or three instrument arms and one endoscope arm -- that execute the surgeon's commands. The laparoscopic arms pivot at the 1-cm operating ports eliminating the use of the patient's body wall for leverage and minimizing tissue damage. Supporting surgical team members assist in installing the proper instruments, prepare the 1-cm port in the patient, as well as supervise the laparoscopic arms and tools being utilized.
• EndoWrist® Instruments
  A full range of instruments are provided to support the surgeon while operating. The instruments are designed with seven degrees of motion that mimic the dexterity of the human hand and wrist. Each instrument has a specific surgical mission such as clamping, suturing and tissue manipulation. Quick-release levers speed instrument changes during surgical procedures.
• InSite® Vision System with high resolution 3-D Endoscope and Image Processing Equipment
  Provides the true to life 3-D images of the operative field. Operating images are enhanced, refined and optimized using image synchronizers, high-intensity illuminators and camera control units.

The da Vinci Surgical System is the only commercially available technology that can provide the surgeon with the intuitive control, range of motion, fine tissue manipulation capability and 3-D visualization characteristic of open surgery, while simultaneously allowing the surgeon to work through small ports of minimally invasive surgery.”

Device Technologies imports the robot to Australia. They kindly directed us to a website to download the above images. They are from “Intuitive Surgical® ©2005 Intuitive Surgical, Inc.”

The system has many advantages over laparoscopic surgery and “manual” radical prostatectomy.

“The da Vinci® Surgical System:

• Simplifies many existing surgeries
• Makes difficult Minimum Invasive Surgery (MIS) procedures routine
• Makes new MIS procedures possible in most surgical specialties

Surgeon Benefits:

The da Vinci® Surgical System is groundbreaking technology that extends the surgeon’s capabilities in the following ways:

• Enhanced 3-D Visualization: Provides the surgeon with a true 3-dimensional view of the operating field. This direct and natural hand-eye instrument alignment is similar to open surgery with "all-around" vision and the ability to zoom-in and zoom-out.
• Improved Dexterity: Provides the surgeon with instinctive operative controls that make complex MIS procedures feel more like open surgery than laparoscopic surgery.
• Greater Surgical Precision: Permits the surgeon to move instruments with such accuracy that the current definition of surgical precision is exceeded.
• Improved Access: Surgeons perform complex surgical manoeuvres through 1-cm ports, eliminating the need for large traumatic incisions.
• Increased Range of Motion: EndoWrist® Instruments restore full range of motion and ability to rotate instruments more than 360 degrees through tiny incisions.
• Reproducibility: Enhances the surgeon’s ability to repetitively perform technically precise manoeuvres such as endoscopic suturing and dissection.

Patient benefits may include:

• Reduced pain and trauma to the body
• Less blood loss and need for transfusions
• Less post-operative pain and discomfort
• Less risk of infection
• Shorter hospital stay
• Faster recovery and return to normal daily activities
• Less scarring and improved comesis

MIS reduces trauma to the patient by allowing surgeries to be performed through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospitalization costs.”

The blood loss was typically only around 100 ml compared with up to a litre during a normal prostatectomy. One of the reasons for the smaller blood loss is that the abdominal cavity is pressurized with gas. Less blood loss also leads to better vision. Aided by the camera, and its magnification the surgeon’s eye can be virtually within centimetres of the procedure.

If the robot had been around two and a half years ago, I might even have opted for it instead of brachytherapy!

I Fisk

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