Connections: Latest robot allows for one-incision prostatectomy | Summer 2019

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Explore more in the Summer 2019 issue of Connections

From the OHSU Knight Cancer Institute

Dr. Chris Amling headshot

Christopher L. Amling, M.D., FACS

Dr. Amling specializes in treating cancers of the urinary system, including prostate, kidney and bladder cancer. He is an expert in minimally invasive cancer surgery, including robotic surgery for prostate, kidney and bladder cancer.

The first robotic prostatectomy was performed in 2001 with the first generation Intuitive da Vinci Surgical System. Now, urologic oncologists use this method for nearly all radical prostatectomies, or RP.

Though a great leap from open surgery, this robotic method required six small incisions for the robotic arms and cameras. With the latest robotic generation, we’re down to just one, 1-inch incision.

In 2018, OHSU became the first institution on the West Coast to offer the Intuitive da Vinci SP (Single Port) system for urologic and transoral robotic surgery, in an effort to expand precision surgical services and offer the most advanced services in the Pacific Northwest.

The da Vinci robot relies on telemanipulation, which allows surgeons to remotely control instruments from a console, mimicking the movements of the human hand. The newest iteration is the most advanced of its kind, fitting three fully wristed instruments and a flexible camera through a single channel, designed for working in tight, narrow spaces.

For RP, surgeons make a small incision above the umbilicus, put a tube through the abdomen, and deploy the instruments inside. By limiting the number of incisions, the goal is to decrease pain and hasten recovery.

Patient response in the first six months of use shows an impressive lack of pain. Patients report minimal pain, use very little or no pain medication, and go home the next day.

Our urologic oncologists will be some of the first in the nation to objectively evaluate the benefits of the SP compared to standard robotics, but this initial feedback is promising for improved recovery and better cosmetic outcomes.

Within the next six months, we will be expanding the use of the SP robot for other urologic purposes, including reconstructive operations for the kidney and the ureter.

The SP robot also has significant advantages for transoral surgery, allowing access to previously unreachable areas of the oral cavity without invasive methods that often decreased functional outcomes.

The SP will also be beneficial for the increasing list of transgender surgeries OHSU is now providing.

When to refer

We are happy to provide an evaluation or a second opinion on whether robotic surgery with the SP is a good fit for patients.

For urology, this would include those needing robotic prostatectomy or robotic pyeloplasty.

Contact us

From the latest technology to the newest drugs that are increasing survival, OHSU Knight Cancer Institute, Oregon’s only NCIdesignated Cancer Center, offers a full range of options for cancer patients. We are always available to answer questions.

Please call the OHSU Physician Advice and Referral Service at 5034944567. To refer a patient, please fax to 5033466854.

Gamechanger for transoral surgery

The SP robot is ideal for treating cancers of the oral cavity, larynx and pharynx.

The new robotic upgrade facilitates even more precise surgical access, potentially expanding utility of transoral approaches to other upper aerodigestive tract sites such as the larynx.

“From the perspective of transoral surgery, the new single port robot offers incredibly streamlined instrumentation, with more dexterity and greater exposure to the pharynx and larynx," said Ryan J. Li, M.D., a specialist in otolaryngology-head and neck surgery, and director of the Head and Neck Robotic Surgery Program at OHSU. "This expands the delicate surgical services we can provide patients.”

Li added, “this new-generation robotic platform greatly facilitates the exploration and excision of small primary tumors and occult cancers, offering a chance for surgical cure and reduced, precisely targeted radiation doses.”

Robotic-assisted surgery increasing and crossing disciplines

OHSU now has four da Vinci robots.

The acquisition of the da Vinci SP and an additional da Vinci XI for outpatient procedures at the new Center for Health & Healing Building 2 is part of an expansion in the robust OHSU Comprehensive Robotics Program, which began in 2006.

Across disciplines, OHSU has 27 robotic-trained surgeons, who performed more than 600 robotic-assisted procedures in 2018.

We anticipate an increase of 16 percent or greater in 2019. In the last three years alone, robotic surgery volume has nearly doubled.