During a recent surgery, Dr. Arieh Shalhav sits several feet from the patient, manipulating robotic instrument controls and a miniaturized optics system as he works to remove a cancerous prostate gland.



Robotic surgery–a skill Shalhav is learning–is still a rarity, but it is poised to become more popular as patients push doctors to adopt technology that can make surgery less stressful.



While robotic equipment is expensive, at about $1.2 million a station, it does reduce a patient’s pain and recovery time, doctors said.

And robotics also is easier on surgeons, allowing them to sit at a control console while they work.



Those are significant improvements, said Shalhav, who is skilled at using laparoscopic equipment to remove prostates. Inlaparoscopic procedures, instruments are inserted into the body at the end of tubes and are manipulated by hand.



Like robotic surgery, laparoscopic procedures reduce stress on the patient by avoiding a major cut to enter the body.



But the laparoscopic prostatectomy is difficult to learn and arduous to execute, said Shalhav, who practices at the University of Chicago.



It requires the surgeon to stand so he is directly above the patient to manipulate the tools manually.



“I have to work standing on one leg for four hours,” said Shalhav. “By the end, I am very tired.”



Shalhav said that even at this early point in his experience with robotics, it seems clear that it is as good as traditional surgery at removing cancerous tissue.



One common side effect of prostatectomies–urinary incontinence–is no more a problem with robotic surgery than with the traditional procedure, he said.



Sexual impotency is also often associated with prostatectomies done in the traditional fashion, and Shalhav said it will take time to determine how well robotic surgery does at avoiding that outcome.



Dr. Greg Zagaja, a University of Chicago urologist skilled in traditional prostate surgery, said he is learning robotic surgery because of the benefits to patients.



“The learning curve is steep,” said Zagaja, “but after doing 10 to 20 cases, it should be easy to replicate the results we get from open surgery.”



At Detroit’s Henry Ford Hospital, where surgeons have done hundreds of robotic prostatectomies, they report the procedure now takes less time than standard surgery.



And, thanks to fewer complications and a shorter recuperation, robotic surgery has become economically attractive–even with the hefty $1.2 million for the equipment, the $100,000 a year in maintenance and about $1,500 per patient procedure in disposable equipment costs.
More here.