In urology new operating techniques have usually developed early historically. Among them are the cystoscopy, the endoscopy and the laparoscopy. Laparoscopic operations have the advantage of minimal invasivity, less blood loss, less pain and faster rehabilitation. The use of a telemanipulator ("robot") was not conceivable in practical everyday life until a few years ago. Now it has become routine for demanding laparoscopic operations.
A NEW ERA IN PROSTATE CANCER OPERATING TECHNOLOGY
The da Vinci telemanipulator
The word "robot" derives from the Czech "robota" = slave. Today mature robots work according to the man-machine (master-slave) principle: the operator sits at a control console and works with the instrument handles for each hand and with several foot pedals. These movements are recognised by the computer via sensors and relayed via a wiring harness to the 3 - 4 instrument arms that are placed over the patient. Thus the most different instruments (end effectors) as well as the optics can be adapted to the requirements of the operation. A tremor filter, which suppresses the trembling of the human hand, provides a high degree of precision. The three-dimensional (with up to a10-fold magnification) projections of the operating field on a special monitor within the console as well as the scalability of the instrument movements (enlargement or reduction) increase precision enormously. The success of the operation depends to a great extent on the experience and care of the surgeon. Thus the system achieves only the best benefit when it is used by really experienced and well-trained specialists, as both of our urologists are.
... with ergonomic console
... and precise, free-moving instruments
Only complex laparoscopic procedures are suited to a robotic-assisted operation, which, on the one hand, requires microscopically precise work and, on the other hand, challenging reconstruction. The complete removal of the prostate gland (radical prostatectomy) due to prostate cancer is thus the most frequent operation for the da Vinci system worldwide. The number of robotic-assisted prostatectomies doubles annually in the USA. In 2005, according to information from Intuitive Surgical, already 20% (ca. 17,000) of all radical prostatectomies in the USA were performed with robotic assistance.
SUMMARY AND OUTLOOK
The robotic-assisted laparoscopy will significantly improve urological operating techniques in the years to come. The robotic-assisted laparoscopic prostatectomy allows conservative prostate removal with less loss of blood and good maintenance of erectile function as well a brief catheter and hospitalisation time. Further indications suitable for the use of the da Vinci telemanipulator are operations on the kidneys and ureters as well as further selected laparoscopic procedures on the small pelvis.
Concepts for photo caption: The da Vinci telemanipulator with ergonomic console and precise, free-moving instruments.