The new Da Vinci surgical system could help reduce side effects and speed up recovery time after prostate cancer surgery, writes Fiona Gartland.
Space-age robotic technology could revolutionise prostate cancer surgery in Ireland and result in fewer side effects for patients, according to a Galway-based consultant.
The technology, originally developed by Nasa and the US Department of Defense, allows surgeons to operate at high levels of precision without ever touching their patients.
Ireland has the third-highest rate of prostate cancer in Europe, with 1,130 new cases diagnosed every year and 500 deaths from the condition annually.
Treatment offered includes radical prostectomy, the complete removal of the prostate gland.
Generally carried out through open surgery or occasionally through laprascopic surgery (using telescopic rods through small incisions), the operation is often a successful cure for cancer, but it can leave patients with unwanted side effects, including impotence and incontinence.
The new technology could help to change that, says Prof David Bouchier-Hayes, consultant urologist at the Galway Clinic, a private hospital.
The procedure requires just five small cuts. A surgical assistant inserts a tiny camera and different instruments, all attached to robotic arms, into the patient's body through pen-size holes.
The surgeon sits at a computer console and monitors a 3-D image magnified 10 times from the camera inserted in the patient, then using master controls, he manipulates the robotic arms and they mimic his movements to perform the surgery.
The system allows for high precision, with robotic "wrists" inserted inside patients that have seven degrees of motion, one more than the human wrist.
And an in-built mechanism also filters out unintentional movement such as any natural tremor in the surgeon's hands.
The incisions required to insert the robotic arms are typically one centimetre long, so cosmetically the outcome is better for patients. And because surgery is carried out at such a fine level, the after-effects are lessened.
"Everything can be seen in greater detail than in open surgery and the movements are better than laproscopic surgery," explains Bouchier-Hayes.
Patients' discomfort is significantly reduced, the risk of bleeding and damage to other organs is reduced and the two biggest side effects which can be caused by radical prostectomy, impotence and incontinence, are also lessened because the fine nerves which control those functions can be seen more easily and can more easily be teased away."
At the Royal Melbourne and Western Hospital, Melbourne, Australia, where Bouchier-Hayes trained for three years in the use of robotics.
Two per cent of patients undergoing prostectomy using the new technology required blood transfusions, compared with up to 30 per cent of those who had traditional open surgery.
Recovery time and length of stay in hospital were also shorter for those operated on using the new technology.
"The state of Victoria has five million people, and 95 urologists [ Ireland has 25]," he says.
"Yet 48 per cent of radical prostectomies for the whole state are being performed in the Royal Melbourne. Patients are better informed and want this option."
The technology, developed by American company Intuitive Surgical and marketed as the "Da Vinci Surgical System", was approved for prostatectomy by the Food and Drug Administration in May 2001. It has since been approved for other surgery including some thoracic, cardiac and gynaecological procedures.
In the future, cardiologists may be able to perform critical cardiac surgery without ever having to stop the patient's heart.
According to Bouchier-Hayes, one "Da Vinci" is being sold every three days and in the US, 40 per cent of radical prostatectomies will be performed using it this year. There are also six centres in England currently offering it to patients.
Bouchier-Hayes and the Galway Clinic hope to bring the technology to Ireland by the summer but the biggest obstacle is cost.
Over five years it costs €3.5 million to fund and works out at about €25,000 for every procedure. The clinic is in negotiation with the VHI about what they would pay per procedure, but so far the figures aren't adding up.
Passing the cost on to the patient may not be ideal, but could be inevitable.
"We don't want to be elitist and ration health care out, we want to be able to offer it to everyone, but the cost is high," he says.
"One of the things we want to do is to set up a charitable concern that would allow us to offer the treatment to public and private patients. We need to bring this to the men of Ireland because they are being devastated by this cancer," he says.
"Open surgery is a good operation if a man wants to be saved from dying from prostate cancer, but this is a better option."