PROSTATE CANCERPROSTATE CANCER

da Vinci Robot Surgeryda Vinci Robot Surgery

Cedric Emery, MD. FACSCedric Emery, MD. FACS

VenturaUrology.comVenturaUrology.com

Every man with Prostate Cancer is unique. Every man with Prostate Cancer is unique. The variables in each man are: The variables in each man are:

1.1. AgeAge2.2. HealthHealth3.3. PSAPSA4.4. Gleason scoreGleason score5.5. StageStage6.6. PersonalityPersonality7.7. and more….and more….

•Today there are approximately 250,000 new diagnoses of Prostate Cancer yearly – most are cured.

• In 1970, most men died of complications from obstruction, kidney failure or bone pain.

TREATMENTSTREATMENTS

1. Watchful waiting1. Watchful waiting2. Radiation 2. Radiation • External IMRTExternal IMRT• Brachytherapy (seeds)Brachytherapy (seeds)3. Cryotherapy (freezing)3. Cryotherapy (freezing)4. Surgery4. Surgery• Open radical nerve-sparing Open radical nerve-sparing

prostatectomyprostatectomy• Robotic da Vinci Radical nerve Robotic da Vinci Radical nerve

sparingsparing

5. Hormonal5. Hormonal

6. Chemotherapy6. Chemotherapy

7. Immunotherapy 7. Immunotherapy

da Vinci Robotic da Vinci Robotic ProstatectomyProstatectomy

I will discuss today the da Vinci Robotic I will discuss today the da Vinci Robotic surgery, which we have had here at surgery, which we have had here at CMH for the past two years. CMH for the past two years.

But first, let me show you how patients But first, let me show you how patients can choose the ideal therapy for can choose the ideal therapy for themselves. themselves.

You Are FortunateYou Are Fortunate

The great thing about our CMH The great thing about our CMH Hospital and community is that we Hospital and community is that we offer all these treatment options. offer all these treatment options.

The physicians in our community who The physicians in our community who utilize these options are excellent. utilize these options are excellent.

You are fortunate to have our hospital You are fortunate to have our hospital as your home base. as your home base.

Your Job!Your Job!

1.1. Read *book/s on prostate cancerRead *book/s on prostate cancer2.2. Obtain second opinionsObtain second opinions3.3. Ask questionsAsk questions4.4. Decide which treatment option best Decide which treatment option best

suits your needs. suits your needs. ** The Prostate; A Guide For Men The Prostate; A Guide For Men and the Women Who Love Them,and the Women Who Love Them, by by Pat Walsh, MD.Pat Walsh, MD.

EXAMPLE CASESEXAMPLE CASES

What treatment would be best for What treatment would be best for these men? these men?

Let’s take 5 patients with three Let’s take 5 patients with three variables made the same: Age 75, variables made the same: Age 75, Gleason 7, rising PSA of 8. Gleason 7, rising PSA of 8.

What do you think?What do you think?

75-year-old male, Gleason 75-year-old male, Gleason 7, rising PSA of 87, rising PSA of 8

#1#1

• Heart diseaseHeart disease

• Not sexually activeNot sexually active

• Stage T2bStage T2b

Rx: Consider Rx: Consider CryotherapyCryotherapy

75-year-old male, Gleason 75-year-old male, Gleason 7, rising PSA of 87, rising PSA of 8

#2

•Healthy

•Sexually active

•Stage T2b

Rx: Consider da Vinci Radical Prostatectomy

75-year-old male, Gleason 7, 75-year-old male, Gleason 7, rising PSA of 8rising PSA of 8

#3•Healthy•Sexually active•Large obstructing prostate with

slow stream•Stage T2b

Rx: Consider Open Radical, nerve-sparing, Prostatectomy

75-year-old male, Gleason 7, 75-year-old male, Gleason 7, rising PSA of 8rising PSA of 8

#4

•Healthy or Unhealthy

•Sexually active

•Stage T3b

Rx: Consider Radiation: IMRT, Seeds or both

75-year-old male, Gleason 7, 75-year-old male, Gleason 7, rising PSA of 8rising PSA of 8

#5

•Healthy or unhealthy

•Sexually active

•Stage T4b

Rx: Consider Complete/Intermittent Hormonal Blockade

• The surgeon’s The surgeon’s hands are placed hands are placed in special in special devices called devices called masters that masters that direct the precise direct the precise instrument instrument movementsmovements

The Surgeon Directs The The Surgeon Directs The InstrumentsInstruments

• Traditional laparoscopic Traditional laparoscopic instruments are straight instruments are straight and do not bendand do not bend

• EndoWristEndoWrist®® Instruments Instruments move like a human wrist move like a human wrist – Allows increased Allows increased

dexterity, dexterity, maneuverability, and maneuverability, and precisionprecision

Wrist and Finger MovementWrist and Finger Movement

• da Vincida Vinci®® Surgical Surgical System System EndoWristEndoWrist®® Instruments are Instruments are small and are able small and are able to fit through to fit through keyhole incisionskeyhole incisions

• A wide range of A wide range of instruments are instruments are availableavailable

Small Instruments through Small Instruments through Keyhole IncisionsKeyhole Incisions

Benefits of Benefits of da Vincida Vinci™ ™ ProstatectomyProstatectomy

• Decreased blood lossDecreased blood loss• Shortened length of hospital stayShortened length of hospital stay• Decreased postoperative painDecreased postoperative pain• Less scarringLess scarring• Shorter urinary catheter timeShorter urinary catheter time• Faster return to regular activitiesFaster return to regular activities• Anticipation of improved potency and Anticipation of improved potency and

continencecontinence

Robotic-Assisted Surgery Robotic-Assisted Surgery AccessAccess

Open Surgical Incision da Vinci™ Prostatectomy Incision

Compare the Benefits and Compare the Benefits and Decide What’s Best for YouDecide What’s Best for You• Open ProcedureOpen Procedure

– Long IncisionsLong Incisions– Hospital Stay of 2.5 daysHospital Stay of 2.5 days– Blood Loss 300mlBlood Loss 300ml– Catheter removal in 21 daysCatheter removal in 21 days

• Robotic-Assisted ProcedureRobotic-Assisted Procedure– 5 or 6 small keyhole incisions5 or 6 small keyhole incisions– Hospital stay of 1.2 daysHospital stay of 1.2 days– Blood Loss 153 mlBlood Loss 153 ml– Catheter removal in 7 daysCatheter removal in 7 days– Back to work in 2 weeksBack to work in 2 weeks

da Vincida Vinci®® System System Evolution of surgeryEvolution of surgery

– Open surgery: mid-19Open surgery: mid-19thth Century Century

– Minimally invasive surgery: late 1980’sMinimally invasive surgery: late 1980’s

– Robotic (Intuitive) surgery w/ da Vinci: Robotic (Intuitive) surgery w/ da Vinci: 19991999

• 3 to 4 Instrument 3 to 4 Instrument

armsarms

• One-piece design One-piece design

for quick set upfor quick set up

da Vincida Vinci®® Surgical Surgical SystemSystem

Surgical CartSurgical Cart

• Hand to eye alignment

• Comfortable ergonomic surgeon position

• NavigatorTM camera control

• One-piece mobile unit

da Vincida Vinci®® Surgical System Surgical SystemSurgeon ConsoleSurgeon Console

• Superior 3-D imaging

• ‘Open’ surgery orientation

InSiteInSite®® 3-D Vision 3-D Vision SystemSystem

Degrees Of FreedomDegrees Of Freedom

Telestration Telestration

• Facilitate da Vinci® training

• Easy to use touch panel

• Route image remotely

Audio Intercom System Audio Intercom System

• Two way communication with OR staff

• Adapts to voice controlled OR systems

A JourneyA Journey

“Taking surgical precision & technique beyond the limits of the human hand.™”