Robotic Surgery For Prostate Cancer

SmartCare: da Vinci system offers small incisions, less blood loss, quick recovery

Ron Spiva's surgery to remove his cancerous prostate gland couldn't have gone more smoothly.

Ron Spiva

Ron Spiva, a pharmacist in Durant,
is among  patients who have enjoyed a
quick recovery after having a radical
prostatectomy with theda Vinci Surgery
System at Genesis, Davenport. He went
back to work after a couple of days.

"I had virtually no recovery time," the 56-year-old pharmacist says of his Sept. 25, 2009 surgery at Genesis Medical Center, Davenport. "I went into surgery at 7:30 a.m. I got back to my hospital room at 2 p.m. Three hours later, I was walking around the hospital. I stayed overnight even though I felt good enough to go home, and I was discharged before noon the next day.

"It was a 100 percent painless surgery. I had no incision pain and took absolutely no pain medication during the recovery."

Instead of the traditional open procedure, urologist Gus Harb, M.D., performed a radical prostatectomy using the latest evolution in robotics technology -- the da Vinci Surgery System. The system allows major surgery through very small incisions -- with unmatched precision.

The da Vinci system is one of the latest technologies of Genesis SmartCare, the array of minimally invasive and noninvasive procedures that get patients back to their normal life sooner. Since February, 2009, more than 150 da Vinci cases have been performed at Genesis.

Helping Hands
During Ron Spiva's surgery, Dr. Harb sat at a surgeon's console situated several feet away from his patient on the operating table. Through the console, he could view anatomy in 3-D while using remote controls to guide the da Vinci's robotic arms through dime-size incisions. The system gave him excellent visualization and dexterity as he navigated the pelvic area.

The da Vinci's thin arms and ability to move in 360-degree circles eliminate the natural tremor of even the most steady surgeon's hands. Surgical tools are held by up to three arms -- which protrude off a machine -- while a fourth arm carries a scope with a tiny camera.

Through the scope, Dr. Harb could see anatomy with 10 times the magnification.

"It's a huge leap in technology and a great advancement for the Quad Cities," Dr. Harb says. "The main benefit of robotic surgery is significantly less blood loss."

In prostate cancer surgery, millimeters matter. Nerve fibers and blood vessels are attached to the prostate and must be delicately separated from the prostate before its removal. The precision, vision and control of the da Vinci System help spare nerves that are vital to erectile function, for example.

"The da Vinci is intuitive and very precise," Dr. Harb explains. "Because robotic surgery is more refined and has great magnification, you see better and probably preserve more tissue for sexual function. There's also faster recovery of urinary continence."

The incision size for an open prostatectomy is about 14 centimeters vs. five small incisions with a robot-assisted prostatectomy. "We don't cut the muscle in either procedure," Dr. Harb explains. "The pain comes when you violate the muscle."

1 in 6 Will Be Diagnosed
Ron Spiva's journey to prostate cancer surgery began last summer, when a routine check-up showed his PSA (prostate-specific antigen) level had increased substantially in a year's time.

"Because of the acceleration rate, it warranted me to have a biopsy. Urologist Dr. David Rohlf performed my biopsy, and I was very surprised to learn I had early-stage prostate cancer. He referred me to his colleague Dr. Harb because I was a candidate for the da Vinci robotic surgery," Spiva says.

The prostate is a male reproductive gland that produces a fluid found in semen. Located below the bladder, the prostate surrounds the urethra, the tube that empties urine from the bladder. Patients who face a radical prostatectomy have concerns about potential side effects like incontinence and loss of sexual function.

"Dr. Harb was very confident, and I also had done my own research, that the da Vinci robotic surgery had the best chance of sparing the nerve tissue," Spiva of Bettendorf says. "I felt that with this procedure, I had a better chance of everything working correctly after the surgery."

Treatment for prostate cancer -- ranging from conservative management, hormonal deprivation, cryosurgery, radiation therapy with either external beam or brachytherapy, and surgical removal of the prostate -- depends on a number of factors, including the stage of the disease, age, health and personal preference.

"Ron was a good candidate for robotic surgery because he was fairly young and healthy; his prostate size was good; and, his prostate cancer was not the most aggressive kind," Dr. Harb says.

About 1 in 6 American men will be diagnosed with prostate cancer in their lifetime. With greater public awareness, early detection is on the rise and mortality rates are declining.

Prostate cancer screening should begin at age 50 for Caucasians who are not at high risk. African- Americans and people at high risk for prostate cancer should begin screening at age 40.

"In the last 10 years, mortality for prostate cancer decreased by 28 percent, and that's because we're taking care of it early -- thanks to early detection," Dr. Harb says. "About 90 percent of patients we see have a fairly early stage of prostate cancer; we rarely see metastasis. Unfortunately in the African- American community, prostate cancer is still under-diagnosed and tends to be more aggressive and frequent."

For more information on da Vinci prostatectomy, go to www.davinciprostatectomy.com.

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1227 E. Rusholme Street Davenport, IA 52803 563-421-1000