First time a modern Da Vinci robot was applied in 1998. Today this surgical system is used for performing surgeries in Germany and all over the world. Currently there are more than 52.000 surgeries in prostate cancer performed by Da Vinci method. The first surgery assisted by Da Vinci robot lasted 420 minutes. Nowadays such surgeries in Germany take only 120-180 minutes thanks to the technological improvements and many years of practice.
8 biggest German clinics offer Da Vinci prostatectomy treatment (among them the Clinical Center of Friedrichshafen, Berlin Charité Clinic, Heidelberg University clinic and the others).
Nowadays prostate cancer removal (radical prostatectomy) is the most efficient method of treatment for this type of cancer. The prostate removal can be conducted either as a traditional surgical operation or as da Vinci prostatectomy.
During da Vinci prostatectomy the doctor can detect the areas of prostate affected by cancer with maximum precision; moreover, da Vinci prostatectomy does not damage healthy cells.
Traditional surgical operation (cutting into the abdomen or perineal cavity and removing the prostate with a scalpel) can result in serious consequences like urinary incontinence and impotence, because there exists a risk of damaging the nerve tracts responsible for erection (on each side of the prostate) and muscles responsible for continence during the prostate removal procedure.
Unlike other methods of prostate cancer treatment, da Vinci prostatectomy is a laporoscopic surgery (done without cutting into the abdomen or perineal cavity). It is conducted by a surgical robot under the guidance of a human surgeon. The da Vinci robot can enhance the precision of da Vinci prostatectomy and, as a result, reduce the risk of complications for the patient. The cost of Da Vinci prostatectomy surgery: from 12.000 €.
The da Vinci surgical system makes it possible to effectively perform operations in various areas of medicine. These are gynecology, urology, cardiac surgery, gastroenterology, oncological surgery and other areas of surgery that require minimal intervention and the most accurate actions.
As with any surgical intervention, minimally invasive surgery with the da Vinci surgical system can put the patient’s health under threat. There are certain restrictions on such operations. The decision can be taken only by the doctor in charge who observes the patient from the moment of admission to hospital. For example, this procedure is unacceptable for patients with blood clotting problems, pregnant women and overweight people. However, the majority of patients can be operated on with the help of the robotic system, and appreciate its positive aspects in comparison with conventional abdominal surgery.
Currently, the da Vinci surgical system is used in:
- Surgical andrology and urology
- Surgical gynecology
- Reconstructive surgery
- Thoracal surgery
- Surgical gastroenterology
- Surgical endocrinology
The robotic da Vinci surgical system is equipped with special instruments that ensure good maneuverability, no worse than that of a surgeon’s hands. This feature makes it possible to make the most precise and accurate motions when performing surgical operations. The built-in processor analyzes the surgeon’s motions at a speed of 1000 units per second and sends signals to the tools, eliminating any possible manifestations of tremor. The console can reproduce all motions made by the surgeon’s hand and fingers. It differs from laparoscopy, where the surgeon works using 30 cm long rods.
Ergonomic Surgeon’s Console
During the operation the surgeon sits at the convenient console which displays a three-dimensional image of the area that is operated. The convenience of working with such a console favorably affects the surgeon’s work, since he does not get tired as during a standard surgical intervention. The surgeon controls the telemanipulator with the help of special joysticks that react to the touch of the fingertips. His motions are reproduced by the robotic system with absolute precision. It ensures high quality of the operation and increases its safety. The surgeon’s motions are transmitted to the operating table of the system in real time.
The da Vinci surgical system is equipped with ultra-precise manipulators with four arms, one of which has a built-in camera that transmits real-time images to the console. Two arms replace the surgeon’s hands during the operation, and the fourth serves as an assistant. Incisions as long as 1-2 cm are made with the help of the “scalpel” located at the end of the laparoscopic “arm”. Due to such small incisions, the level of tissue injuries is reduced.
The accuracy of the movements of the mechanical manipulators exceeds the capabilities of human hands. With seven degrees of freedom and the ability to bend to 90 degrees, the robotic arms have a wide range of movement amplitude. It is essential for a surgical intervention in a confined space, for example, when working with the pericardium or pelvis. A team of human assistants monitor the work of the da Vinci robotic system, preparing the area for the incisions, watching the course of the operation, bringing in sterile instruments.
EndoWrist Surgical Instruments
The large range of surgical instruments that the robotic system uses for operations are invaluable support for a human surgeon. The wide capabilities of their mobility make it possible to reproduce even the smallest motions made by the doctor. In addition, each motion is scaled and converted into a signal for ultra-precise simulation. Each of the available instruments fulfils its specific role. They are tissue preparation, clamping, suturing and so on. At the same time, the clamping lever helps to control the speed of instrument change in clarity. The accuracy of the movements that the da Vinci surgical system provides makes it possible to avoid such a natural human physiological phenomenon as tremor. Surgeons can work with hard-to-reach areas of organs without the risk of damaging healthy tissue.
The vision system, which is an essential element of the system, makes it possible to transfer high-quality images to two colour screens in 3D. Thanks to this feature, the surgeon has an idea of the surgical picture. In this case, the transmitted image can be enlarged, optimized, amplified and suppress noise due to the use of a special synchronizer, a powerful light source, as well as the console. The surgeon receives a high-quality image, without flickering, in order to precisely control the picture of the operative field of the organ. Only those specialists who have enough experience in the relevant field of medicine and practical experience in handling robotic technology are allowed to work with the da Vinci surgical system. Due to its convenience and high degree of accuracy, the da Vinci system has a very wide range of applications.
Thanks to the technical advantages of the da Vinci prostatectomy technique and the surgeon’s skillful chances for patients’ quick recovery greatly increase. The specific character of the operation technique is that this modern method is a road to a new, long life. From the point of view of the patient’s quality of life, the goal of the operation is the complete excision of the tumour, the preservation of renal function and the preservation of erectile function.
After the da Vinci operation, the patient can return to normal daily life activity the next day. He is able to move independently around the hospital room and in some cases may even take unhurried walks. On the fifth day after the surgery, in the case of the successful healing of the postoperative sutures, the urethral catheter is removed and the next day the patient is discharged from the hospital.
One of the objectives of the operation is the preservation of the neurovascular bundles responsible for erectile function. A skilled surgeon who works with the da Vinci system is able to fully preserve the neurovascular bundles adjacent to the prostate, which ensures the preservation of potency. Of course, in this case the patient’s general condition plays a significant role ‒ if the tumour has grown considerably and extends beyond the prostate capsule, the surgeon will have to remove some of the nerves located near the prostate gland. In general, sexual function is restored within a few months, but in some cases within a year. It depends on the patient’s physical characteristics and the size of the tumour. For men younger than 50, the possibility of saving the potency is over 90%, younger than 60 years of age ‒ 75%, younger than 70 ‒ 57%, over 70 years of age ‒ 25-50%.
On average, at the time of discharge from hospital, patients can hold their urine.
According to statistics, 76% of patients can hold their urine after the catheter is removed on the 5th day after the surgery. Over time, the men’s condition improves, and 85% of them are able to fully hold urine for 6 months after the removal of the prostate gland. The percentage of patients who are unable to hold urine a year after the surgery is less than 3%. It should be noted that each person is unique; therefore, the function of the bladder to hold urine is restored in different people in different ways and within different periods. After the surgery patients may experience urinary incontinence, and for six months after the surgery the ability to hold urine may fluctuate.
The important benefits for patients are:
- first of all, such a procedure is the safest for a patient, since access to the operative field is performed through small incisions (from 5 to 12 mm). If we compare the traditional surgery, the minimum incision is 10 cm;
- the risk of considerable blood loss and consequently the need for blood transfusion, which can often lead to a deterioration in the patient’s condition, are ruled out;
- the risk of infection is reduced;
- the time spent in hospital is reduced;
- the pain that often accompanies the postoperative period is minimized;
- low risk of undesirable side effects in comparison with open surgery;
- the patient’s rehabilitation period shortens, which makes it possible to quickly return to the usual rhythm of life;
- tiny postoperative scars that quickly inosculate and generally do not bother patients in the future.
The important benefits for surgeons are:
- thanks to the system, it is possible to achieve a high degree of accuracy of movements and a wide range of motions. Having a visual and tactile connection with the system, the surgeon fully controls the process and projects his movements onto the tiny point of the instrument;
- excellent degree of visualization of the operative field. A three-dimensional image of the operated organ with high resolution for the clearest picture;
- high degree of dexterity. Mechanical arms of the robotic system make it possible to reproduce the movements of the human hand and even more. The surgeon’s motions, received by the system, are analyzed, filtered and imitated with the help of the instruments.
Urology department of Friedrichshafen Clinic Centre offers a wide range of modern robot-assisted surgeries. More than 1500 qualified doctors and mid-level medical staff work in the clinic. In addition to in-patient and ambulatory treament, the clinic also does active university-based research in Tübingen University Clinic. This collaboration results in high scientific and technological level of treatment. New methods and types of treatment are constantly introduced. For example, in 2011 Friedrichshafen Clinic received a patent for using special robotics technology and, as a result, joined four major certified da Vinci centres in Germany. Each year about 1000 da Vinci surgeries are conducted in the urology department.