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|Laparoscopic, Robot assisted Cystectomy|
For those undergoing cystectomy, a new option is being studied; minimally invasive, laparoscopic surgery using advanced technology, the "da Vinci" robot, which is approved for surgeries involving the abdomen, pelvis, and chest.
As with any operative technique, experience is crucial; if you are considering this option, be sure to inquire as to how many cystectomies the surgeon has performed using the robot. Is it in the clinical trial setting? Another possible drawback is the lack of long term data regarding cancer control. Though general concensus of researchers till now is that cancer control - the goal of any oncological procedure - does not appear suffer, the approach is too new to be certain at this point in time. Also, until the urinary diversion can be performed using the robot, much of the advantage offered by this technique in other cancer procedures is lost, since the surgeon does have to make an open incision (albeit a bit smaller) to perform this part of the procedure.
For younger people interested in the latest cystectomy techniques, be sure to ask if the surgeon is capable of doing the state of the art, orthotopic neobladder (which allows for normal voiding through the natural urethra), as reports indicate that more people undergoing robotic surgery end up with either the continent reservoir or the external bag.
Studies using the da Vinci robot for radical prostatectomy have shown better results with nerve-sparing, and it's hoped that this added benefit will translate over to cystectomy patients.
The surgeon is able to operate with more precision, and experiences less fatigue than when peforming conventional cystectomy surgery. Visualization in 3D provides the surgeon with a better view of the operating field, and the robot's arm provides improved dexterity while performing bladder removal and reconstruction.
The surgeon's finger motions, conveyed through sophisticated joy sticks, direct the minute maneuvers carried out by two robotic hands holding surgical instruments. The surgeon views the surgery on a computer screen, which shows an enlarged and three-dimensional view of the surgical area. The images are transmitted by a tiny camera with multiple lenses, which is attached to a third robotic hand.
Data indicate that robot-assisted laparoscopic surgery has a shorter learning curve than conventional laparoscopic surgery, and that operative time can be reduced.1
Where is da Vinci?
Roswell Park Cancer Institute, New York; Experts from the urologic-oncology department -pioneering this technique since 2005 - are currently doing one of the largest series on the use of robotically assisted cystectomy for bladder cancer .
Conclusions: Robotic-assisted RC appears to offer some operative and perioperative benefits compared with the open approach without compromising pathological measures of early oncological efficacy, such as lymph node yield and margin status. Larger, randomized studies with long-term follow-up are required to confirm these findings and establish oncological equivalence. Pub Med Abstract
1. Technology Insight: surgical robots-expensive toys or the future of urologic surgery? N Peter Wiklund; Department of Urology, Karolinska University Hospital, 171 76 Stockholm, Sweden Nature Clinical Practice Urology (2004) 1, 97-102doi:10.1038/ncpuro0055
2.SHAH G, HAAS G Using of daVinci Robot(R) in U.S. and Worldwide
|Last Updated ( Friday, 14 November 2008 )|