Mohamad E. Allaf, M.D., Assistant Professor of Urology and Biomedical Engineering at the Johns Hopkins University School of Medicine, is the Director of Minimally Invasive and Robotic Surgery at the Brady Urological Institute. Dr. Allaf has performed more than 300 robotic-assisted prostatectomy procedures using the da Vinci Surgical System. In this excerpt from an article in our Prostate Bulletin, Dr. Allaf talks about the advantages of having a radical prostatectomy performed robotically.
Dr. Allaf: First, let me make one thing very clear: Prostate surgery is only going to be as good as the surgeon who performs it. If you are not a skilled surgeon, you will not be a skilled robotic surgeon. That said, there are several distinct advantages of robotic prostate surgery. Here's a review of each potential advantage:
- Less blood loss. Results from multiple centers specializing in robotic surgery have indicated that patients undergoing robotic-assisted radical prostatectomy have less blood loss than in traditional open surgery. This can mean that the patient leaves the hospital with a higher blood count and has a lower chance of requiring a blood transfusion.
- Shorter hospital stay. Many of my patients leave the hospital the day after their operation. While this cuts down on hospital costs, we really don't know if the overall convalescence is any faster. Some data suggest that it may be.
- Better visualization. If I can see better, it provides me with an advantage. Surgeons can wear loupes (magnification glasses) to help them see better during an open procedure. But robotic magnification is a true advantage. You are "up close and personal" and get a lot more magnification than you could with magnification loupes.
The problem with wearing loupes is that an inexperienced surgeon may lose his or her field of vision as the magnification increases. Go up from 4X to 6X magnification and what you see through your glasses is a smaller surgical field. With the optical system of the robot, the entire field is magnified. Furthermore, the optical system is angled and can allow the surgeon to see around corners.
In a man with a deep pelvis -- and in an obese patient in particular -- the surgeon is operating within a deep hole, which makes open surgery far more challenging. With a camera inside the patient, however, the surgeon's field of vision is the same whether the patient is obese or lean.
Another unique advantage of the robot arises when the patient has had previous hernia surgery and now has a mesh support in place. In an open procedure, you sometimes have to cut away the mesh to get at the prostate. The robotic procedure avoids the mesh by going underneath it.
