Da Vinci Robot Assisted Prostate Surgery


Email Raji.Kooner@svha.org.au or call 02 8382 6980 for a confidential appointment.

Da Vinci robotic procedure1 is relatively straightforward. 

The patient gets wheeled into the operating theatre, they’re put to sleep by the anaesthetist. 

We make small incisions inside the abdomen, we insert little instruments inside little ports that go inside. 

We connect the gas to these ports and that inflates the abdomen and this gas pressure is usually higher than the vein pressure and that’s why we don’t get much bleeding. 

We then bring in the surgical cart, the main part of the robot that attaches to the instruments. 

After they’ve attached on we put the camera in and then I unscrub. 

I unscrub and go to the console, it’s a 3D view like an IMAX theatre. 

There’s two cameras inside in the patient, it marries the image together and we get these three dimensional view and as I move my hand controls the instruments inside replicate my hand movements. 

We actually have more degrees of movement than my wrist. 

So the instruments replicate around, it’s like being shrunk into a little person and being suspended inside the abdomen and operating. 

And as I press a food pedal I can activate a fourth arm. 

So it’s like having a spare set of hands inside the patient and really what happens is we can zoom right down to this inaccessible area, we’re right in front of it. 

We have 10 times magnification, we can go around the corner with the camera and with the instruments we can peel off the nerves for erection and at the end we can do an extremely accurate anastomosis of join between the bladder and urethra to ensure that we have exact apposition, so we have less complications2. 

So this operation now takes me less time than the time most people take to do open surgery, we’re usually done in about an hour and a half or two hours robotic time with about 15 minutes either side for preparation and we’re able to do two cases and we can often do three cases a day if need be, it’s a very relaxing procedure because you’re very comfortable. 

As a surgeon you’re not tired after the operation. 

It’s quite an easy procedure for everyone, the anaesthetist, the bedside surgeon, the nursing sisters now and we’ve been very, very happy with the clinical outcomes3.

References

1. Robotic Prostatectomy - John Hopkins Medicine - https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/robotic-prostatectomy
2. Donata von Reibnitz, Andrea Weinzierl, Carlotta Barbon, et al - 100 anastomoses: a two-year single-center experience with robotic-assisted micro- and supermicrosurgery for lymphatic reconstruction - J Robotic Surg 18, 164 (2024). https://doi.org/10.1007/s11701-024-01937-3
3. Christina Niklas, Matthias Saar, Britta Berg - da Vinci and Open Radical Prostatectomy: Comparison of Clinical Outcomes and Analysis of Insurance Costs - Urol Int . 2016;96(3):287-94. doi: 10.1159/000431104. Epub 2015 Jul 9.