Robotic Prostatectomy / The Da Vinci Surgical System
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).
a surgical proctor, teaching other urologists how to perform
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
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
does the procedure with regularity, with a volume of 4-8 cases/month.
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.
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
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.
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.
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.
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.
here for information about Penile Rehabilitation Following
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.
at (707)224-7944 if you would like more information or would like
to arrange a consultation to discuss these treatment options.