Procedure Information
Laparoscopic Radical Prostatectomy has been performed in Tauranga since 2000, so robotic assistance is a natural progression for our site. (Wilson L, Kennett K, Gilling P. Laparascopic Radical Prostatectomy: An Analysis of the Learning Curve. ANZ J Surg 2004; 74:1065-1068)
Robotic surgery is new to New Zealand but the same system is used throughout the United States, Europe, Australia and many other centres world wide. The robotic system was introduced in 1999 and is now the standard practice in the US for prostatectomies (60-70% in 2008).
The first robotic surgery in New Zealand was carried out at Grace Hospital in Tauranga on 3 September 2007 by Australian Surgeon Peter Sutherland. The first robotic surgery by a New Zealand Surgeon was also done at Grace Hospital in Tauranga by Peter Gilling on 16 November 2007.
From our local surgical experience and studies world wide, it has shown that in the majority of cases hospital stay is shorter (an average of 24 hours), less pain relief is required post-operatively, there is less blood loss and quicker return to daily activities. In the US, research suggests that the return of continence and potency is at least equal to the best results achieved by open radical prostatectomy.
Our Robot Surgical team consists of two Urologists, Peter Gilling and Liam Wilson, Surgical Assistant and Data Manager Jo Pickford, scrub nurse specialists Stephanie Pringle and Jo Dunstan supported by Theatre Manager Ingrid Fisher. Our non-surgical robot team consists of Kim Inskeep, Clinical Manager, who organises the patient experience and Helen Morgan, Administration Manager, who looks after the financial aspects of the business.
It is well established that standard laparoscopy has benefits over open surgery. These advantages include reduced post-operative pain and analgesia requirements, shorter hospital stay and faster return to work and normal activities.
The daVInci robot is a significant technological advance on standard laparoscopy, which allows more complex surgery to be performed more efficiently. There are three main advances. Firstly, the surgeon console reconstructs the surgical field in three dimensions. This replicates the “feel’ of open surgery, and avoids the 2D images of standard laparoscopy. The robot also magnifies the surgical field by up to a factor of 10. This enhances the precision of the operation, with improved haemostasis and less blood loss, and increased ability to preserve important structures such as the neurovascular bundle. Lastly, the EndoWrist instruments effectively mimic the movements of the human hand. This allows the surgeon to perform complex movements not previously attainable by conventional laparoscopy.
In a study by Badani et al of over 2,700 patients, 96.7% of men undergoing a robotic prostatectomy were discharged within 24 hours of surgery. Post-operative narcotic analgesia requirements were also significantly less. In comparison, discharge within 48 hours of an open radical prostatectomy is extremely unusual; less than 5% of patients would be discharged within that timeframe.
Evolution of robotic radical prostatectomy: assessment after 2766 procedur
Promed Urology has a national and international reputation for the treatment of cancers, laser surgery and female urology. Paediatric conditions, erectile dysfunction and urinary stone disease are also special interest of our group.
© 2008