Robot Assisted Laparoscopic Radical Prostatectomy
Minimally Invasive Removal of the Prostate
One in six American men will be diagnosed with prostate cancer within their lifetime. Approximately 27,000 men die annually due to prostate cancer, making it the second most fatal cancer in men. Advances in the early detection and treatment of this disease are believed to have sharply increased survival. Ten-year disease specific survival rates of patients with radical prostatectomies are greater than 90% for low grade adenocarcinomas, greater than 85% for medium grade adenocarcinomas. When removal of the prostate is warranted, several important factors regarding the procedure are commonly taken into consideration by both patients and physicians:
* Cancer Removal
* Safety
* Urinary Control
* Return to Potency
* Pain
* Blood Loss
* Return to Work/Activities
With such important issues at stake, it is important that patients receive the very best treatment possible. That is why the Department of Urology at UCI was one of the first institutions to offer Laparoscopic Prostatectomy assisted by the da Vinci Robotic Slave Interface. This groundbreaking technology, listed as number one in Forbes Magazine's "Five Robots That Will Change Yourda Vinci Surgical System Life," provides unprecedented laparoscopic vision and precise robotic instrument manipulation. The initiation of this UCI Department of Urology advanced technology was put in the skilled hands of its most capable prostate surgeon, Dr. Thomas Ahlering. Dr. Ahlering was already a very highly regarded surgeon in Urologic cancers, being listed as one of the original "America's Best Doctors" since his membership in 1994 and had already performed 400+ open radical prostatectomies, before transitioning to the da Vinci system.
Now in his sixth year of robot-assisted surgery, Dr. Ahlering has perfomed minimally invasive robotic prostatectomies on nearly 700 patients. The University of California, Irvine robotic-assisted laparoscopic prostatectomy experience is one of the oldest programs in the world. UC, Irvine has published the 2nd largest series on robotic prostatectomy in the literature. Since the robotic program inception in 2002, Dr. Ahlering has written 23 scientific publications and book chapters, specifically on this new laparoscopic method, of which 5 papers bring forth new advancements in techniques. This work demonstrates that robotic prostatectomy produces superior outcomes for the patient in reduced blood loss, nearly zero blood transfusion, low complication rates, earlier return to work, and excellent oncological outcomes with low positive margin rates. The rate of return for pad-free urinary control in men is ~80% at 3 months and ~94% at one year after surgery. These findings validate the wisdom of the transition from open surgery to the robotic laparoscopic technique
In November 2004, UCI published and presented our new robotic technique for preserving the nerves for potency without the use of electrocautery at the 2004 World Congress of Endourology. This work was made especially significant when a paper published by the John Hopkins group showed a pronounced delay in the return in potency in dogs, with the use of electrocautery near the potency nerves. We recently published the early results of our new technique to avoid damage to the potency nerves in the 2006 July/August issue of Journal of Endourology. Currently we find ~50% of pre-potent men <66 yrs with unilateral or bilateral nerve preservation return to erections firm enough for intercourse within 3 months and ~80% after 9 months. Perseverance of the surgeon to improve technical methods, and assembly of an excellent surgical team are important standards that UC, Irvine employs. We view validated methods of measuring patient follow-up in the assessment and reporting of surgical outcomes, as essential tools to measure the true progress of robotic technology.
Surgeons come from around the world visit UCI on a weekly basis, via our Mini-Residency and Intuitive da Vinci training programs, to learn from Dr. Ahlering's techniques. In May 2007, Dr Ahlering and UCI will repeat hosting a special one day symposium on Advanced Robotic Technique featuring the leaders in robotic prostatectomy. And in May 2007, he will direct a course on Robotic Prostatectomy Techniques at the National American Urological Association Meeting. His recent honors include Physician of Excellence, Orange Coast Magazine (2005), and Intuitive Surgical's Pioneer of da Vinci Urology Surgery (2005).
The robotic prostatectomy is neither experimental nor a fad. In just 3 years robotic RLP has experienced geometric growth in the United States. In 2003 there were 2,648 procedures performed, in 2004 there were 8,642 and for 2005 an estimated 16,500 cases, or nearly 20% of all radical prostatectomies performed for the year.