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New Administrative Leader Takes Reins at CUMC
Clinical Care
| Robot-Assisted Surgery for Prostate Cancer More Popular at CUMC Physician shows procedure improves outcomes, quality of life post-surgery |
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Since the use of robots in prostate surgery was approved by the FDA in 2000, robotic-assisted laparoscopic prostatectomy, or RALP, has become the most common type of surgery for prostate cancer in the country. Now, Ketan Badani, MD, director of robotic
The findings, published in Cancer [2007 Nov 1;110(9):1951-8], detail outcomes for more than 2,700 patients who underwent the procedure for prostate cancer. RALP has evolved from a relatively obscure procedure just a few years ago to the most common type of prostate cancer surgery today. Still, a certain level of uncertainty about the value of robot-assisted surgery for prostatectomy has existed. Dr. Badani hopes the findings from his latest study will put any uncertainty to rest. “We found that RALP was just as good as conventional surgery for cancer-control, but the remarkable thing was that complications were much more rare and urinary control and sexual function dramatically improved,” he says. “Quicker recoveries meant the patient got back to work and resumed normal activities sooner and a faster return to continence was also observed. Remarkably, the blood transfusion rate was under 2 percent. In conventional surgery it can be as high as 25 percent to 30 percent.” Since being recruited to Columbia in September by Mitchell C Benson, MD, George F. Cahill Professor and chair of the Department of Urology, Dr. Badani has joined Dr. Benson as a robotic surgeon and spearheaded the drive to keep Columbia in a national leadership position in RALP surgery. Dr. Badani, who has performed RALP more than 700 times, says the study’s findings confirmed what he had already observed clinically. “Patients are ecstatic after this surgery because they can’t believe the operation is so non-traumatic,” he says. “I don’t think that a few years ago anyone would have believed we’d get to the point where robotic prostatectomy is the gold standard.” Prostate cancer is the most common cancer among men; 30,000 men died of the disease in 2004, according to the American Cancer Society. But for the hundreds of thousands of men who survive, post-surgical problems can drastically diminish their quality of life because of issues with urinary incontinence and impotency. For the surgeon, prostate cancer is also challenging – it is especially difficult to remove the cancerous prostate while attempting to preserve delicate nerves, arteries and muscles responsible for normal urinary and sexual function. “The operation is complex but this technique allows greater surgical control than is possible with conventional tools,” says Dr. Badani, who trained for six years in laparoscopic and robotic oncology at the Vattikuti Urology Institute at Detroit’s Henry Ford Hospital, the birthplace of robotic prostatectomy. In RALP, the surgeon makes six tiny holes in the patient’s abdomen, instead of the conventional incision in the lower abdomen, and the laparoscopic instruments are carefully inserted and attached to the robot. Once the setup is complete, the surgeon sits at the console where he or she controls the robotic instruments. The machine itself consists of a surgeon’s console with four arms – one controls the movement of the three-dimensional camera, one works as a retractor and the other two control laparoscopic instruments that allow the surgeon’s hand movements to be replicated. Because the robotic “hands” are able to move in as many directions as wrists and fingers, the effect is one of unparalleled exactitude and control, enabling maneuvers that can spare the most delicate tissues. The robotic arms eliminate even the smallest, barely noticeable human hand tremors, making movements remarkably steady. In addition to Dr. Badani and Dr. Benson, the robotic and minimally invasive urology team includes Erik Goluboff, MD, professor of clinical urology and director of urology at the Allen Pavilion; James McKiernan, MD, assistant professor of urology and vice chair of the Department of Urology; Jaime Landman, MD, associate professor of urology and director of minimally invasive surgery; and Benjamin Spencer, MD, assistant professor of urology, who specializes in outcomes research. With Dr. Benson and Steven Corwin, MD, executive vice president and chief operating officer of NewYork-Presbyterian, and the hospital’s leadership team, Dr. Badani is establishing a robotic surgery program at the Allen Pavilion of NYPH, located in northern Manhattan. Dr. Badani has already trained two other physicians in the RALP technique and plans to teach many more, even while expanding the types of surgeries in which robots might be used. “A noticeable advancement is seen in kidney surgery, for example,” Dr. Badani says. “This will be an important improvement in caring for patients with kidney cancer by removing just the cancerous tissue and sparing the normal portion of the kidney. Robot surgery has also been utilized for radical cystectomy [surgery to remove the bladder], where it has many of the same advantages as in RALP. Robots in surgery are definitely the wave of the future.” —Keely Savoie |
