Using minimally invasive robotic surgery to treat urological conditions has rapidly grown as an option for many patients. Henry Mayo recently acquired a da Vinci Xi Surgical System, an instrument that utilizes advanced robotic, computer and optical technologies to assist surgeons. The system is designed to allow surgeons to perform minimally invasive surgery with enhanced vision, precision, dexterity and control. It includes a 3D high-definition (3D-HD) vision system that gives a surgeon a close –up view of the area he or she is operating on.
Listen as Dr. Sevan Stepanian discusses how robotic-assisted surgery for urological conditions has many benefits for the patient, including smaller incisions, less blood loss, less pain and faster recovery times.
Selected Podcast
Robotic Assisted Surgery for Urological Disorders
Featured Speaker:
Sevan Stepanian, MD
Sevan Stepanian, MD is board-certified in urology and completed a fellowship in minimally invasive and robotic surgery at Swedish Medical Center in Seattle. Transcription:
Melanie Cole (Host): Using minimally invasive robotic surgery to treat urological conditions has rapidly grown as an option for many patients. The da Vinci Surgical System offers a minimally invasive alternative to both open surgery and laparoscopy because it requires only a few tiny incisions and offers greater vision, precision and control for the surgeon. Patients can often recover sooner and move on to additional treatments if needed and get back to daily life quicker. My guest today is Dr. Sevan Stepanian. He is a board-certified urologist and a member of the medical staff at Henry Mayo Newhall Hospital. Welcome to the show Dr. Stepanian. What urologic procedures can be performed using robotic technology?
Dr. Sevan Stepanian, MD (Guest): Thanks Melanie, for having me. Urological procedures that are really set up to be amenable to robotic surgery would be things like prostatectomy for prostate cancer, or removal of kidney tumors for kidney cancers, certain types of reconstructive procedures on the kidneys for patients who have obstructions of the kidney and other kinds of pelvic reconstructive surgery.
Melanie: So, then tell us a little bit about some of the benefits or how is this different than performing these procedures using traditional surgical methods? What did you used to do?
Dr. Stepanian: Right, so the jump really to robotics came from laparoscopic surgery. So, laparoscopic surgery was minimally invasive surgery that was done through tiny incisions, usually for intraabdominal processes, intraabdominal types of surgeries and robotic surgery is that same type of approach but it just uses a surgical robot to help or to assist. And so, the robotic platform offers several advantages. The camera is an improved camera, so we have better vision, three-dimensional vision a stereoscopic vision, so we can see things more clearly. The tools themselves, the instruments are very specialized and have much more of what we call degrees of freedom; so, the instruments are wristed, they sort of replicate the human hand, the instruments are much smaller. And so, the improved vision, the smaller instruments, the scaling that the robot does to kind of reduce our little tremors that we may naturally have; all allows us to perform what I feel is a better surgery.
Melanie: So, what about the benefits to the patient? Let’s start there. As far as recovery time, and you know, all of that sort of thing recovering sooner and getting back to their activities. How does that work for them?
Dr. Stepanian: Right, so certainly compared to open surgery, the recovery has been demonstrated to be much, much improved. And so, we will have many patients that are able to leave the next day after having a urological surgical procedure done using the da Vinci System, pain control is easier to attain and so a lot of patients may not require narcotics postoperatively. Patients are up out of bed and walking sooner and so that reduces complications. But patients are really on their feet and get back to their daily activities a lot faster as compared to other surgical approaches. Additionally, functional outcomes are better and so and in some cases, cancer control outcomes are better. It is somewhat of a controversial topic and there is a lot of data that is really coming out now, but there’s an argument to be made that potentially you could do a better cancer operation using the robotic system and you could have improved functional outcomes so for example, in prostatectomy, patient’s postoperative erectile dysfunction is a very really issue and postoperative urinary incontinence is a very real issue and we are starting to see now a little separation in patients who have had robotic surgery doing a little better from that aspect as compared to open surgery or laparoscopic surgery.
Melanie: So, you got right ahead of me. Because I was going to ask you about prostatectomy and sparing the delicate nerves so that some of those side effects that men are afraid of might be limited. So, speak about how it does that.
Dr. Stepanian: Right, so the robot itself doesn’t do it but it allows for it and so in patients who are good candidates to have a nerve sparing procedure done, and not everybody is, in patients who are good candidates; the vision, the magnification, the limited amount of bleeding; all of these things allow us to see tissues better, tissue planes better and when we are trying to peel the very delicate as you described nerves off of the prostate, there is a very fine line between where the prostate is and where the nerves are. And so, if we can see that line better, we can potentially spare those nerves better without really getting into the prostate and just do a cleaner dissection of that area. And less handling of the tissue also helps with recovery afterwards.
Melanie: So what about benefits to you surgeons? How does it help you positionally or with the vision and precision control?
Dr. Stepanian: Right. That’s funny, nobody really asks about us. But we are sitting, so it is nicer that way. It is a little more ergonomic as compared to laparoscopic surgery or open surgery particularly with pelvic surgery. We would have to contort our bodies in certain ways to get down to be able to visualize deep in the pelvis but with the robot, since the camera is coming in straight at a more direct angle, it is a much – it’s much more improved vision in that area, but in terms of benefits to us; it’s the ergonomics, so sitting, less surgeon fatigue, allowing us to sort of maintain our focus throughout the entirety of the case and then as I mentioned before, the robotic system can scale your movements and so depending on your comfort level, you can adjust what that scale looks like in real life and so it can scale your movements down and so any tremor that you may have, sort of gets eliminated and then again, just being able to see better. Those are all things that really make it a joy to perform surgery robotically.
Melanie: So, Dr. Stepanian, what extra training is required to use this da Vinci Robot? I mean is it something that is pretty easy to learn? Or does it take quite a while to master it?
Dr. Stepanian: It takes a while to master it, just like any surgery does. There is no formal additional training sort of within surgical residency programs as of yet. I think that is a topic of discussion and research and that has yet to be determined how that’s going to be rolled in or folded into training programs, but once surgeons are out and are comfortable doing laparoscopic surgery; and most surgeons in most programs get trained on how to do laparoscopic surgery; depending on their comfort level, they can either jump into robotic surgery or Intuitive, the company itself, has training programs that are available and so they will actually have patients come out to their facility in Sunnyvale California and do hands-on sessions and animal labs and things like that to get up to speed and then there are proctoring processes that are in place and these are institution specific, but you know doing a case with a proctor, having somebody observe you for a set number of cases until you are sort of cleared and you have got the go ahead. That’s the typical course.
Melanie: So, wrap it up for us in summary. What would you like people to know about urologic conditions and disorders and the treatment options available using the da Vinci Robot?
Dr. Stepanian: Well first of all, I would like patients to know that in this community, we have the robot available which really allows us to do state-of-the-art surgery, so there is no need to go elsewhere. We have got great surgeons in the area. But it is the most advanced robot that is available on the market and ultimately, we want to try to improve patient outcomes and we are seeing that with the robotic system. With properly trained surgeons, patients are getting out of the hospital faster, there is less pain involved, less narcotics involved, they are potentially getting better cancer operations done with better cancer control and potentially not needing additional therapy afterwards. And they have improved functional recovery in many cases and so it’s about improving patient outcomes and that’s the bottom line and that’s the reason why the hospital is committed to the system and so many surgeons are now committed to the system.
Melanie: Thank you so much Dr. Stepanian. It is really great information. This is It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, you can visit henrymayo.com. That’s henrymayo.com. This is Melanie Cole, thank so much for listening.
Melanie Cole (Host): Using minimally invasive robotic surgery to treat urological conditions has rapidly grown as an option for many patients. The da Vinci Surgical System offers a minimally invasive alternative to both open surgery and laparoscopy because it requires only a few tiny incisions and offers greater vision, precision and control for the surgeon. Patients can often recover sooner and move on to additional treatments if needed and get back to daily life quicker. My guest today is Dr. Sevan Stepanian. He is a board-certified urologist and a member of the medical staff at Henry Mayo Newhall Hospital. Welcome to the show Dr. Stepanian. What urologic procedures can be performed using robotic technology?
Dr. Sevan Stepanian, MD (Guest): Thanks Melanie, for having me. Urological procedures that are really set up to be amenable to robotic surgery would be things like prostatectomy for prostate cancer, or removal of kidney tumors for kidney cancers, certain types of reconstructive procedures on the kidneys for patients who have obstructions of the kidney and other kinds of pelvic reconstructive surgery.
Melanie: So, then tell us a little bit about some of the benefits or how is this different than performing these procedures using traditional surgical methods? What did you used to do?
Dr. Stepanian: Right, so the jump really to robotics came from laparoscopic surgery. So, laparoscopic surgery was minimally invasive surgery that was done through tiny incisions, usually for intraabdominal processes, intraabdominal types of surgeries and robotic surgery is that same type of approach but it just uses a surgical robot to help or to assist. And so, the robotic platform offers several advantages. The camera is an improved camera, so we have better vision, three-dimensional vision a stereoscopic vision, so we can see things more clearly. The tools themselves, the instruments are very specialized and have much more of what we call degrees of freedom; so, the instruments are wristed, they sort of replicate the human hand, the instruments are much smaller. And so, the improved vision, the smaller instruments, the scaling that the robot does to kind of reduce our little tremors that we may naturally have; all allows us to perform what I feel is a better surgery.
Melanie: So, what about the benefits to the patient? Let’s start there. As far as recovery time, and you know, all of that sort of thing recovering sooner and getting back to their activities. How does that work for them?
Dr. Stepanian: Right, so certainly compared to open surgery, the recovery has been demonstrated to be much, much improved. And so, we will have many patients that are able to leave the next day after having a urological surgical procedure done using the da Vinci System, pain control is easier to attain and so a lot of patients may not require narcotics postoperatively. Patients are up out of bed and walking sooner and so that reduces complications. But patients are really on their feet and get back to their daily activities a lot faster as compared to other surgical approaches. Additionally, functional outcomes are better and so and in some cases, cancer control outcomes are better. It is somewhat of a controversial topic and there is a lot of data that is really coming out now, but there’s an argument to be made that potentially you could do a better cancer operation using the robotic system and you could have improved functional outcomes so for example, in prostatectomy, patient’s postoperative erectile dysfunction is a very really issue and postoperative urinary incontinence is a very real issue and we are starting to see now a little separation in patients who have had robotic surgery doing a little better from that aspect as compared to open surgery or laparoscopic surgery.
Melanie: So, you got right ahead of me. Because I was going to ask you about prostatectomy and sparing the delicate nerves so that some of those side effects that men are afraid of might be limited. So, speak about how it does that.
Dr. Stepanian: Right, so the robot itself doesn’t do it but it allows for it and so in patients who are good candidates to have a nerve sparing procedure done, and not everybody is, in patients who are good candidates; the vision, the magnification, the limited amount of bleeding; all of these things allow us to see tissues better, tissue planes better and when we are trying to peel the very delicate as you described nerves off of the prostate, there is a very fine line between where the prostate is and where the nerves are. And so, if we can see that line better, we can potentially spare those nerves better without really getting into the prostate and just do a cleaner dissection of that area. And less handling of the tissue also helps with recovery afterwards.
Melanie: So what about benefits to you surgeons? How does it help you positionally or with the vision and precision control?
Dr. Stepanian: Right. That’s funny, nobody really asks about us. But we are sitting, so it is nicer that way. It is a little more ergonomic as compared to laparoscopic surgery or open surgery particularly with pelvic surgery. We would have to contort our bodies in certain ways to get down to be able to visualize deep in the pelvis but with the robot, since the camera is coming in straight at a more direct angle, it is a much – it’s much more improved vision in that area, but in terms of benefits to us; it’s the ergonomics, so sitting, less surgeon fatigue, allowing us to sort of maintain our focus throughout the entirety of the case and then as I mentioned before, the robotic system can scale your movements and so depending on your comfort level, you can adjust what that scale looks like in real life and so it can scale your movements down and so any tremor that you may have, sort of gets eliminated and then again, just being able to see better. Those are all things that really make it a joy to perform surgery robotically.
Melanie: So, Dr. Stepanian, what extra training is required to use this da Vinci Robot? I mean is it something that is pretty easy to learn? Or does it take quite a while to master it?
Dr. Stepanian: It takes a while to master it, just like any surgery does. There is no formal additional training sort of within surgical residency programs as of yet. I think that is a topic of discussion and research and that has yet to be determined how that’s going to be rolled in or folded into training programs, but once surgeons are out and are comfortable doing laparoscopic surgery; and most surgeons in most programs get trained on how to do laparoscopic surgery; depending on their comfort level, they can either jump into robotic surgery or Intuitive, the company itself, has training programs that are available and so they will actually have patients come out to their facility in Sunnyvale California and do hands-on sessions and animal labs and things like that to get up to speed and then there are proctoring processes that are in place and these are institution specific, but you know doing a case with a proctor, having somebody observe you for a set number of cases until you are sort of cleared and you have got the go ahead. That’s the typical course.
Melanie: So, wrap it up for us in summary. What would you like people to know about urologic conditions and disorders and the treatment options available using the da Vinci Robot?
Dr. Stepanian: Well first of all, I would like patients to know that in this community, we have the robot available which really allows us to do state-of-the-art surgery, so there is no need to go elsewhere. We have got great surgeons in the area. But it is the most advanced robot that is available on the market and ultimately, we want to try to improve patient outcomes and we are seeing that with the robotic system. With properly trained surgeons, patients are getting out of the hospital faster, there is less pain involved, less narcotics involved, they are potentially getting better cancer operations done with better cancer control and potentially not needing additional therapy afterwards. And they have improved functional recovery in many cases and so it’s about improving patient outcomes and that’s the bottom line and that’s the reason why the hospital is committed to the system and so many surgeons are now committed to the system.
Melanie: Thank you so much Dr. Stepanian. It is really great information. This is It’s Your Health Radio with Henry Mayo Newhall Hospital. For more information, you can visit henrymayo.com. That’s henrymayo.com. This is Melanie Cole, thank so much for listening.