Robot-Assisted Prostate Surgery
the prostate and bladder — that could
only be reached by open surgery
techniques. The depth of the surgery
prevents ease of movement with the
arthroscopic instruments without
making large skin/tissue incisions. The
surgeon now requires many axes of
instrument movement — not available
with handheld arthroscopic instruments.
If a particular surgery requires 90 degree
positioning of scissors or forceps to
reach a particular area of interest, the
surgeon could enter from another hole
in the body, or use an instrument that
can rotate at the end with several
degrees of freedom (such as many
industrial and experimental robot arms).
This is the technique practiced by
surgeons using the da Vinci system.
With the operating site so deep
within the patient’s body and only small
holes in the skin and underlying tissue
available, the surgeon is limited in how much he or she can
actually move the ends of the Endo Wrist instruments — the
working ‘hands’ of the robotic system (more on this in a
moment).
Many months of intensive training is required before a
surgeon begins to feel at ease with using a console 10 feet
away from the patient to perform delicate surgeries. Instead
of observing a bladder that is the size of a baseball to a
softball with a plum-sized prostate gland attached to it
several feet below his face on an operating table, the
surgeon can now see in high-definition 3D a bladder that is
the size of a soccer ball with a prostate gland the size of a
baseball directly in front of his face.
FIGURE 8. 'Out cold' on the table, draped in cloths, and
ready for the robot.
in cloth and clear plastic in preparation for the surgery.
How the EndoWrist Surgical
Instruments Work
Before talking about the actual surgery, let me describe
the instruments and how they work when attached to the
robot. Figure 9 shows three of the Endo Wrist instruments
given to me by my surgeon. At $2K to $2.5K each, these
instruments can only be used 10 times. This limit was set
Pre-Operation Procedures
After my initial check-in at 5: 30 in the
morning, I was given a gown, prepped in the pre-op room, hooked up to several IVs, and wheeled
into the operating room on a gurney. Quite
frankly, I don’t remember anything after the pre-op. I could have been signing over my first-born
and my house for all I knew (Figure 7) as
everyone in the operating room was crowding
around me.
Before the actual procedure, I was transferred
to an operating table and my body was tipped
head down to allow my gastrointestinal system to
move away from the area of the operation. The
anesthesiologist had to adjust the respiratory
pressure because of this position to keep my lungs
at full capacity. Figure 8 shows how I was draped
FIGURE 9. Three Endo Wrist instruments; one with
the cover removed and one with the
interconnecting disks shown.
SERVO 04.2012 77
