Prostate cancer is the most common cancer in men. It is estimated by the American Cancer Society that 218,890 men will be diagnosed and 27,050 men will die of prostate cancer in 2007. The American Cancer Society recommends that early diagnostic testing begin at age 50 with a blood test called prostate specific antigen (PSA) and a digital rectal examination (DRE). This is lowered to age 40 in African-American men and those with a family history of prostate cancer. If prostate cancer is diagnosed, further testing may be required to determine if the cancer is localized or has spread beyond the prostate. When cancer is localized to the prostate, patients have several curative options including a radical prostatectomy (complete prostate removal) or radiation treatments (including protons). A detailed discussion of the management options with a urologist and other cancer specialists will help clarify the risks and benefits of the various management options.

University of California, Davis Medical Center has two da Vinci robots to facilitate a less invasive form of surgical treatment. A robotic surgery program also requires a committed and specifically trained team of doctors, nurses, and technicians. In fact, more than 50 robotic procedures are performed monthly here at UC Davis.

For select patients, the da Vinci robot allows the surgeon to remove the prostate through small punctures using pencil sized instruments. This helps facilitate our commitment to minimizing pain and convalescence and yet at the same time improve outcome measures, such as erectile function and urinary control. Two UC Davis urologists, Drs. Christopher Evans, and Theresa Koppie have completed training on the da Vinci robotic system and are considered experts at the procedure. During the operative procedure the surgeon sits at a controlling console near the patient. A bedside assistant surgeon is next to the patient. As the surgeon watches the operative field though the camera, he controls the robotic arms from the console and the robot arms replicate the surgeon's movements. The cancerous prostate is removed using operative principles of radical prostatectomy refined over the last several decades.

The operating robot has several potential advantages over standard surgical techniques. One advantage is in recovery time. The operation is performed laparoscopically through small punctures and less time is required to heal. Most patients are able to return to normal activity in 2 to 3 weeks instead of 6 to 8 weeks seen with standard open surgery. There is less blood loss during a robotic prostatectomy, resulting in a higher blood count. A higher blood count provides for quicker return of strength and stamina after surgery. As with any surgical procedure, these benefits cannot be guaranteed as surgery is both patient and procedure dependent.

The US Military initiated research on operating robots as a method of allowing experienced trauma surgeons to operate on battlefield casualties from a remote location. Recent technological advances have allowed incorporation of robotics into routine clinical care including the radical prostatectomy operation. The concept of using robots in surgery is attractive because it combines the precision and accuracy of a machine with the judgment of an experienced surgeon.

The da Vinci surgical robot in use

The da Vinci System enhances surgical capabilities by enabling the performance of complex surgeries through tiny surgical openings. The System cannot be programmed nor can it make decisions on its own. The da Vinci System requires that every surgical maneuver be performed with direct input from your surgeon. The robot employs a unique camera system allowing the surgeon to enjoy an image at 10 times magnification. The robot's computer fuses the images of two small cameras to give the surgeon a binocular three-dimensional image on the screen. This accurate visualization allows a closer view of the muscles and nerves involved with urinary control and sexual function, respectively. By seeing in such detail the surgeon can visually identify the junction of the prostate with the urinary sphincter and precisely cut the urethra leaving the muscles needed for urine control intact. In addition, the magnified view allows the surgeon to see and move aside and out of harm's way the nerves along side the prostate which are necessary for erections.

The da Vinci Surgical System has been successfully used in thousands of prostate cancer procedures world-wide.

• Greater Surgical Precision
  Permits the surgeon to move instruments with such accuracy that the current definition of surgical precision is exceeded.
  
• Enhanced 3-D Visualization
  Provides the surgeon with a true 3-dimensional view of the operating field.
  
• Increased Range of Motion
  EndoWrist® Instruments restore full range of motion and ability to rotate instruments more than 360 degrees.

• 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

Christopher P. Evans, MD, FACS
Professor & Chair
Department of Urology

Theresa Koppie, MD
Assistant Professor
Department of Urology

For more information call the UC Davis Urology Clinic at (916) 734-2222 or (800) 770-6930. Or, contact the Center for Virtual Care at (916) 734-7808.