ROBOTIC SURGERY :

In 1997,Dr. Menon was recruited to become chairman of urology at Henry Ford Hospital to revive the prostate cancer program,Menon and the staff at the VUI would develop robotic procedures in general,( for example bladder,Kidney cancer ) and the prostatectomy in particular,The robotic prostatectomy developed by Menon is called the “Vattikuti Institute Prostatectomy”. Specialized Laparascopic instruments are used for the procedures. During the operation
images from a 3-D camera are projected to a remote console.

The surgeons operates in virtual reality,observing the images on a screen.

This technology serves to make the surgery less invasive and more precise.

Dr. Menon has performed nearly 40,000 robotic prostatectomies,and is considered a world authority on the use robotic surgery for prostate cancer.

THE ROBOTIC PROSTATECTOMY :-

About the VIP Procedure:—-
This is currently our preffered procedure for removal of the prostate.A team of surgeons led by Mani Menon,M.D,performs the operation.We have performed over 4000 such operations over a 7-year period,the word’s largest experience.The unique procedure combine the oncological principles of “open “ radical prostatectomy with the minimum invasiveness of laparascopic surgery,Established by Dr. Menon.

With the state of the art “da Vinci” system,the surgeon uses a three – dimensional computer vision system to manipulate robotic arms.These robotic arms hold special surgical instruments that are inserted into the abdomen through tiny incisions. A laparascope- a long,thin,lighted telescope- is inserted through one incision and connected to the computer monitor that allows the surgeon to see inside the body.

The three-dimensional view helps the surgeon more easily find and preserve the delicate nerves and muscles that surround the prostate. The robotic arms can rotate a full of 360 degrees. This allows the surgeon to manipulate surgical instruments with greater precision and flexibility.

The prostate,nearby lymph nodes,seminal vesicles and adjacent tissues are removed through the small incisions,which are closed with few stiches. With the robotic technology,surgeons can manipulate instruments with greater precision and flexibility. Most patients go home within 24 hours and return to normal activity within 2 weeks after surgery. Patients walk the evening of surgery and begin a clear diet one day after surgery. Most patients have very little pain after the robotic procedure.
To qualify for this type of surgery,patients must be free of other significant health problems and be within a fairly normal weight range.

The Following side effects can occur any time a prostate is removed. In our experience,they are less with VIP than with open prostatectomy.

-Sexual Function.
-Urinary Continence
-Scarring

Comparing Robotic Vs. Open Prostate Surgery:—

Patients at the Vattikuti Urology have told us they are most concerned about the following factors when deciding what type of prostate cancer treatment to undergo:
Cancer Removal
Urinary Continence
Erectile Function
Safety
Pain
Blood Loss

Cancer Removal:—-
Surgeons measure their success in eliminating cancer from a patient’s body by looking at the surgical margins- or the edges of tissue on the removed prostate – and by measuring the PSA blood test after surgery . A pathologists will look at the removal prostate under microscope ,and if he sees cancer cells on the edge of the prostate ,this is called a positive margin.The reverse of a positive margin is a negative margin – indicating all the cancer in the prostate has been removed.
Whether a cancer can be removed completely depends on two factors,the skill of the surgeon and how bad the cancer is ,Thus any surgeon ,no matter how good he or she is will not be successful in removing all the cancer ,if the cancer is aggressive or particularly bad,.Pathologists relate the aggressiveness of prostate cancer to tomor volume (how much cancer there is) and to tumor grade (how abnormal the cancer looks under the microscope )At Henry Ford ,Surgeons tend to operate on more aggressive cancers than at institutions.

If the cancer is removed completely ,the PSA should be undetectable after surgery. Dr. Menon has the longest follow up of patients after robotic surgery ,up to 7 years.
Of close to 3000 patients operated upon by him personally,less than 5 percent have had detected PSA in the blood.

Continence at Six Months:—-
When the prostate is removed,one of two muscles that control urination is removed because this muscle lives in the prostate. The second muscle is able to control urination in most men,but it will take some time until this happens.

For patients undergoing open prostatectomy at Henry Ford ,60 percent are NOT wearing pads six months after their surgery,and 25 percent are dry at eight weeks.

For those patients having robotic prostatectomy ,96 percent are NOT wearing pads at six months ,and 90 percent are dry at eight weeks.Infact ,the majority of the patients operated upon this year have had total urinary control within 24 hours after removal of the cathether. In other words,patients undergoing VIP regain continence much faster than patients undergoing conventional surgery.

Potency at Twelve Months:—-
One very common side effect of prostate cancer surgery ( or radiation or hormone treatments ) is erectile dysfunction or the inability to have and sustain an adequate erection for sexual intercourse ,while sexual desire ,organsm and sensation should be the same.,most men notice a change in the quality of erections. This is because the nerves and blood vessels required for erections often are stretched or cut during prostate surgery.
As with continence ,VIP patients appear to regain erectile function faster than patients undergoing open surgery ,and is likely these results will improve with time.

Safety:—-
No matter ,there are risks to every operation ,Complications during surgery can include a hernia at the “port” ,where the scopes are inserted into the body ,post -operative bleeding ,a deep venous thrombosis (DVT) or blood clots that develop in the veins of the legs and pelvis ,etc.
For patients undergoing the open procedure at Henry Ford,85 percent had NO complications. Among VIP patients ,98 percent had NO complications.
This means that the VIP has proven to be safer operation than the open prostatectomy.

Pain:—-
All patients are asked to complete a pain evaluation test upon completion of their surgery.
A score of “1” indicates no pain at all,and a score of “10” indicates the worst pain imaginable.
On average ,patients undergoing the open procedure at Henry Ford indicate an average pain score of “7” and VIP patients indicate an average pain score of “3”.
patients who had the VIP generally have less pain compared to patients who had the open surgery.

Blood Loss:—-
The prostate has multiple large vessels surrounding therefore,bleeding during surgery is a common risk. Sometimes,blood loss is so significant that patients need a transfusion to replace what is lost.
This has happened in 11 percent of patients having open prostate surgery at Henry Ford.
However ,no VIP patient has had to undergo a transfusion due to excessive blood loss.
Therefore ,the risk of transfusion /blood loss with the VIP is much lower compared to open surgery.
Even though most patients undergoing open surgery do not require a blood transfusion ,most of them are anemic when they go home.Most VIP patients (97 percent) are NOT anemic when they go home.Thus,they are able to resume normal activity more quickly than the open surgery patients.

Score:—-
The last row of the table gives a total score for each type of surgery. This score allows patients to compare the two types of operations based on the different factors listed.These score were calculated on what patients considered important. The best possible score for each variable is 100.
Thus,if either the open surgery or the VIP were the perfect surgery.,they would have a score of 600.
Instead ,open surgery at Henry Ford receives a score of 406(76+60+66+85+30+89). The VIP at Henry Ford receives a total score of 552 (91+96+97+98+70+100) ,indicating in a numerical sense the VIP is superior to open surgery at Henry Ford.
Note that the pain score is reversed in this calculation (score of 7 translates to a 30 and a score of 3 translates to a 70) ,because the lower the pain score ,the better the procedure.

TOP 3 HIGHEST PUBLISHING AUTHORS ON ROBOTIC PROSTATECTOMY:—-

MENON ,M (41 PAPERS) (1049 CITATIONS)
TEWARI ,A (31) (843 CITATIONS)
HEMAL ,A.K. (20) (622 CITATIONS)

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