References

1. Walsh PC. Anatomic radical prostatectomy: evolution of the surgical technique. J Urol 1998; 160 (6 Pt 2):2418.

2. Guillonneau B, Vallancien G. Laparoscopic radical prostatectomy: the Montsouris technique. J Urol 2000; 163:1643.

3. Menon M, Shrivastava A, Tewari A, et al. Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary results. J Urol 2002; 168:945.

4. Abbou C, Hoznek A, Salomon L, et al. Laparoscopic radical prostatectomy with a remote controlled robot. J Urol 2001; 165:1964.

5. Bentas W, Wolfram M, Jones J, Brautigam R, Kramer W, Binder J. Robotic technology and the translation of open radical prostatectomy to laparoscopy: the early Frankfurt experience with robotic radical prostatectomy and one year follow-up. Eur Urol 2003; 44:175.

6. Binder J, Kramer W. Robotically-assisted laparoscopic radical prostatectomy. BJU Int 2001; 87:408.

7. Webster T, Herrell S III, Baumgartner R, Anderson L, Smith J. Robotic assisted laparoscopic prostatectomy versus radical retropubic prostatectomy: assessment of perioperative pain. J Urol 2004; 171(4 suppl):44.

8. Tewari A, Peabody J, Sarle R, et al. Technique of da Vinci robot-assisted anatomic radical prostatectomy. Urology 2002; 60:569.

9. Menon M, Tewari A, Peabody J., Members of the VIP team. Vattikuti Institute of Prostatectomy: technique. J Urol 2003; 169:2289.

10. Lee D, Eichel L, Skarecky D, Ahlering T. Robotic laparoscopic radical prostatectomy with a single assistant. Urology 2004; 63:1172.

11. Myers R, Cahill D, Kay P, et al. Puboperinealis: muscular boundaries of the male urogenital hiatus in 3D from magnetic resonance imaging. J Urol 2000; 164:1412.

12. Menon M, Tewari A, Peabody JO, Shrivastava A, Kaul S, Bhandari AK. Vattikuti Institute of Prostatectomy (VIP): a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate. Experience of over 1100 cases. Urol Clin North Am 2004; 31:701.

13. Menon M, Hemal A, Tewari A, Shrivastava A, Bhandari A. The technique of apical dissection of the prostate and urethrovesical anastomosis in robotic radical prostatectomy. BJU Int 2004; 93:715.

14. Epstein J. Incidence and significance of positive margins in radical prostatectomy specimens. Urol Clin North Am 1996; 23:651.

15. Menon M, Shrivastava A, Sarle R, Hemal A, Tewari A. Vattikuti Institute of Prostatectomy: a singleteam experience of 100 cases. J Endourol 2003; 17(9):785.

16. Van Velthoven R, Ahlering T, Peltier A, Skarecky D, Clayman R. Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology 2003; 61(4):699.

17. Nadu A, Salomon L, Hoznek A, et al. Early removal of the catheter after laparoscopic radical prostatectomy. J Urol 2001; 166:1662.

18. Hoznek A, Antiphon P, Borkowski T, et al. Assessment of surgical technique and perioperative morbidity associated with extraperitoneal versus transperitoneal laparoscopic radical prostatectomy. Urology 2003; 61(3):617.

19. Gettman M, Hoznek A, Salomon L, et al. Laparoscopic radical prostatectomy: description of the extraperitoneal approach using the da Vinci robotic system. J Urol 2003; 170(2 Pt 1):416.

20. Wolfram M, Brautigam R, Engl T, et al. Robotic-assisted laparoscopic radical prostatectomy: the Frankfurt technique. World J Urol 2003; 21(3):128.

21. Menon M, Tewari A, Members of the Vattikuti Institute of Prostatectomy team: Robotic radical prostatectomy and the Vattikuti Urology Institute technique: an interim analysis of results and technical points. Urology 2003; 61(suppl 4A):15.

22. Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology 2002; 60(5):864.

23. Tewari A, Shrivastava A, Menon M, Members of the VIP team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int 2003; 92:205.

24. Ahlering T, Skarecky D, Lee D, Clayman R. Successful transfer of open surgical skills to a laparoscopic environment using a robotic interface: initial experience with laparoscopic radical prostatec-tomy. J Urol 2003; 170:1738.

COMMENTARY

Guy Vallancien

Institut Montsouris, Université Pierre et Marie Curie, Paris, France

The positive experience in robotic laparoscopy, presented by the Detroit group, demonstrates the evolution of surgical telemanipulation systems to benefit the surgeon. For instance, during laparoscopic radical prostatectomy, the reanastomosis of the bladder neck to the urethra occurs at the end of the surgery. At this point, the surgeon is often tired, and it becomes more challenging to execute intracorporal sutures. The execution of these sutures, however, is facilitated by the telemanipulation arms of the robot. The robotic arms provide six degrees of freedom, which allows an enormous flexibility in the "wristed arms." This flexibility allows the surgeon to place his needle in virtually any position, without the usual attention required in needle placement in the needle driver. Laparoscopic surgery, furthermore, can be physically exhausting when the surgeon stands next to the operating table for long periods of time. With the robot sitting at the control console, comfort is increased. One can extend this thought by stating that a more comfortable surgeon may execute a better operation. Nevertheless, robot-assisted laparoscopic prostatectomy does not provide any additional benefit to the patient. When comparing traditional laparoscopic prostatectomy to robot-assisted laparoscopic prostatectomy, a tour center, the only significant difference is a greater blood loss with robotic assistance.

What is the future of telemanipulation? I do not believe that teletransmis-sion will be viable in a center where there is not a large volume of cases. Clearly, to acquire such equipment, the center must already be an important referral center with resources available to acquire current technology. Nevertheless, there is a growing interest in robot-assisted surgery, and this interest is attributable to two main reasons:

1. To train young surgeons in surgery and to expose them to difficult cases. As an analogy, the cockpit simulator of an Airbus A320 is extremely realistic. The most dangerous situations are programmed into the computer; and young pilots are trained through simulated events. Similarly, young surgeons will soon be able to learn operations and practise them multiple times, without operating on living patients.

2. The concept of the industrial revolution in medicine. In the future, laparo-scopic prostatectomies can be performed in a large operating room of 250 m2, equipped with four robots. At the Institut Mutualiste Montsouris, we have a laparoscopic prostatectomy training program for scrub nurses. Currently, we do laparoscopic prostatectomies with only a scrub nurse at the operating table. This nurse prepares the patient, handles the robotic instruments, and assists the surgeon with the suction and forceps. At Montsouris, our resident controls the robot and the staff surgeon observes the operation. Our vision is to have four trained laparoscopic nurses and four residents, in this specialized setting, performing laparoscopic prostatectomies simultaneously. One staff surgeon would visit each console or, even with a fifth console, help the residents when required, for instance, in the dissection of the neurovascular bundles or the prostatic apex or in completing a difficult anastomosis. Such an evolution may also minimize long-term costs, because only one anesthetist and circulating nurse would be required for all four operations. Thus, technology has shifted the era of the surgeon as artist to the era of industrial surgery.

CHAPTER

0 0

Post a comment