Robotic Radical Prostatectomy

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A MEDICAL MIRACLE

New ‘da Vinci’ technology a godsend for cancer patients

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in the world of art, Leonardo da Vinci was and is unrivalled as an artist. But in today’s world of science, da Vinci is better recognised as a master surgeon. ‘‘The da Vinci is a miracle of the scientific world’’ said urologist Dr.Kulwat Prasertsuntarasai, one of the first Thai doctors who utilised the da Vinci, the latest minimally invasive robotic technology, in the treatment of prostate cancer.

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In Thailand, the da Vinci was first introduced by cardiologists, who used it during heart operations. That was until February last year when Dr Kulwat first performed a da Vinci prostatectomy, a surgical procedure that removes a diseased prostate gland with the assistance of the new technology.

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So far the urologist has conducted the robot-assisted prostatectomy on almost 50 prostate cancer patients. Even though cancer of the prostate gland is a deadly illness, the robotic surgery promises a near perfect success rate, he noted.

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While women recognise the serious threat that cervical cancer poses, most men on the other hand pay inadequate attention to prostate cancer. The disease sees an abnormal growth of cells in the prostate gland — a small walnut-shaped gland in the male reproductive system that produces seminal fluid, the fluid that nourishes and transports sperms during orgasm.

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In the US, said Dr Kulwat, carcinoma of the prostate is the most common cancer among men. In Thailand, how- ever, prostate cancer ranks fifth among the leading causes of cancer-related deaths, accord- ing to statistics from the Ministry of Public Health.

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Though prostate cancer is not the largest cancer-related threat to men, it shouldn’t be underestimated, since if left unattended the disease can be fatal, noted the doctor.

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Similar to other types of cancer, the exact cause of prostate malignancy is unknown. Nonetheless there are certain risk factors that have been linked to the onset of the disease.

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Age is one of the biggest determining factors in the occurrence of prostate cancer, the specialist explained. Prostate cancer is rarely found in men aged below 40 but the chance of having the cancer rises significantly between the ages of 40 and 45.

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Mostly prostate cancer is hereditary, Dr Kulwat continued. ‘‘If your father has prostate cancer, your risk of having the disease is greater than that of an average man.’’

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Ethnicity is also another significant risk factor. For reasons that are not well understood, black men have a higher risk of developing the cancer, the doctor said. In addition, diets high in fat may be a contributing factor. The disease is therefore much more common in countries where meat and dairy products are dietary staples such as the US, Japan, Singapore and European countries.

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‘‘Those who eat like Westerners are more likely to fall prey to prostate cancer than those who don’t.’’

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The scariest fact about prostate cancer is that the disease is literally a silent killer. Most cases of cancer remain latent and show no symptoms, especially in the early stages. In some cases, the symptoms are similar to those of benign prostatic hyperplasia (BPH), a non- cancer-related condition found in older men, that sees the prostate increasing in size.

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Patients suffering from early stages of pros- tate cancer may show such symptoms as dif- ficulty in urinating, a weak urine stream or a frequent need to urinate during the night, the specialist said.

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Because prostate cancer grows very slowly, many cases of prostate cancer are not detected until the cancer spreads beyond the prostate and invades other parts of the body including the lymph nodes, bones, spine, liver, lungs, adrenal glands and even the brain.

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There are many different ways to treat prostate cancer, depending mainly on the stage of the tumour, and the patients’ age and general health status. There are less invasive treatments such as radiation therapy, hormone therapy, radioactive implants as well as invasive techniques such as surgery.

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Prior to the advent of the da Vinci prostatectomy, patients diagnosed as having prostate cancer were recommended to have the prostate gland removed by way of a large, 20- to 25-centimetre open incision in the lower abdomen, in a procedure called a radical prostatectomy. This conventional approach, Dr Kulwat remarked, commonly results in substantial blood loss, a longer and uncomfortable recovery period, the risk of complications and, last but not least, unwanted scars.

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‘‘Apart from open prostatectomies, we also perform laparoscopic prostatectomies in which a surgeon inserts a narrow instrument with tiny cameras and surgical tools through a few small incisions. But because it is the doctor’s hands that control the instrument, the result is less precise when compared to the robot- assisted procedure’’

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According to Dr.Kulwat, da Vinci prostatectomies are performed with the assistance of the da Vinci Surgical System — the latest and least invasive robotic medical treatment for prostate cancer available. The whole system comprises a surgeon console, micro instruments and a patient-side robotic operator with a high resolution camera that projects a three-dimensional and six to 10 times magnification view of inside the body. This, he added, allows surgeons to conduct the operation with unmatched precision.

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‘‘The robotic surgery offers numerous benefits over traditional surgical approaches including less pain, less risk of infection and complications, less blood loss, fewer scars and faster recovery. Patients undergoing a da Vinci prostatectomy require only a one day or overnight hospital stay while those undergoing open surgery need approximately one week.

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‘‘Most importantly and most desirably, after having a da Vinci prostatectomy, patients will have a quicker return to normal bodily activities, which include urinary continence and erectile functioning,’’ the urologist added.

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But of course, such a medical miracle comes at a price. The da Vinci prostatectomies costs around 500,000 baht in a private hospital while the machine itself costs 100 times the price of the robotic surgery.

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Even with the availability of cutting-edge medical technology like the da Vinci robot, Dr Kulwat said that regular prostate cancer screening is the most important aspect of the treatment of the disease. Those living with the aforementioned risk factors should have annual cancer checks after the age of 45 while those not in the high risk group are recommended to be screened for cancer at the age of 50.

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‘‘But there is no better prevention against carcinoma of the prostate gland than the early detection of the cancerous cells’’ Dr.Kulwat concluded.