Robotic Prostatectomy / The Da Vinci Surgical System

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Napa Valley Register Article 7-7-2008

Dr. James Hendricks:

Is the first surgeon to perform robotic prostatectomy in all of northern California from the North Bay all the way to the northern border of the state (including Sacramento).

Serves as a surgical proctor, teaching other urologists how to perform the procedure.

Has more experience and does more cases than any other private-practice urologist in Northern California.

Has seen outcomes that are equivalent to those of published series from surgeons in academic centers.

The Queen of the Valley Hospital in Napa is the only hospital in the North Bay that has the Da Vinci robotic surgical system.  There is no other hospital in the counties of Napa , Marin, Sonoma , and Solano counties that utilizes this technology.  Dr. Hendricks is the only surgeon at the Queen of the Valley performing robotic prostatectomy.  He does the procedure with regularity, with a volume of 4-8 cases/month.

There are several treatment options for patients newly diagnosed with prostate cancer.  All of these options will be discussed on the prostate cancer page of this website.  One of the options for localized cancer is surgery to remove the prostate.

If a patient is a good candidate for surgery and he decides to go forward with that option, then it is traditionally done using open surgical techniques.  In open surgery, the prostate is removed through an incision in the lower abdomen (radial retropubic prostatectomy) or in the area below the scrotum (radical perineal prostatectomy).

By the end of the 1990's, some centers began performing prostatectomy via the laparoscopic approach, whereby the prostate is removed by making small, keyhole incisions whereby telescopic instruments could be placed which are used to perform the procedure.  Dr. Hendricks used to perform prostatectomy in this fashion. Once relocating to the Bay Area, Dr. Hendricks began utilizing the Da Vinci robot to perform radical prostatectomy. 

When using the robot, the surgeon sits at a console away from the patient .  He is looking at a 3-dimensional image from the camera that is placed inside the patient through a small incision. 

 

His two hands are each controlling a separate instrument, each of which is also placed through a small incision.  These instruments are under precise control by the surgeon and have the same range of motion as the human wrist, making suturing and other complex movements very simple and precise (see images at bottom of page).  While the surgeon is operating, there is a bedside assistant who uses two other small incision sites to place instruments to provide exposure for the surgeon.

With the use of the robot, vision is greatly improved with the 3-dimensional, magnified image the surgeon has that gives much greater detail than is usually seen.  Dexterity is also greatly improved, as more finite movements are able to be performed as the motion of the surgeons' hand can be reduced so that every 5 millimeters the hand moves, the instrument inside can be scaled to move as little as 1/5 as much as that hand.

Dr. Hendricks has seen remarkable results with the use of the robot.  Patients most often leave the hospital the day after surgery and require no pain medication once they leave the hospital.  Recovery is typically 2-4 weeks, rather than 4-6 weeks which is typical for open surgery.  Patients have been found to get full return of urinary control quicker than after traditional surgery as well.  It is also thought that the return of erectile function should be better as well, although there is not enough data available yet to prove that because it is a relatively new technique. 

The nerves that control erections sit just to the side and behind the prostate, as shown in the picture to the right.  When appropriate these nerves can be spared, thus leaving them intact, during surgery.  This is greatly facilitated by the increased dexterity and magnification that the robot provides.  Dr. Hendricks and other robotic surgeons agree that they can definitely better define and preserve the nerves during surgery with the Da Vinci.  Whether this ultimately leads to an increased chance of normal erections after surgery has yet to be proven.

Click here for information about Penile Rehabilitation Following Robotic Prostatectomy.

Most importantly, cancer-control with robotic prostatectomy is equivalent to open techniques in the hands of a qualified surgeon.  Dr. Hendricks has found that his positive margin rate is equivalent to that of published series from surgeons in academic centers. 

Robotic assisted laparoscopic prostatectomy is not for everyone.  When appropriate, however, it is an exciting new treatment option that patients can consider and discuss with their doctor.

Contact us at (707)224-7944 if you would like more information or would like to arrange a consultation to discuss these treatment options.