Haptics- A robotic limitation

The most cited drawback of robotic surgery is the loss of fine feeling of the instruments on tissue.
The other drawbacks are the expense of the surgical system and the need for precise positioning of the robotic arms to provide for a full range of motion without repositioning the arms.

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Smokers have increased risk of bladder cancer after radiation therapy for prostate cancer

A presentation at the AUA Western section meeting was reviewed in the Urology Times November 2005 issue:
UT article: Smokers face higher risk of TCC after radiation
Patients that have a history of smoking are 13 more likely to get bladder cancer (transitional cell cancer) after radiation as compared to patients who get radiation and have not smoked.

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Robotic Surgery Growth

We started our robotic surgery program at Newark Beth Israel Hospital on Dec. 13th, 2004.
Our 9 man group decided to let one person do all of the robotic surgery. Since I had the best combination of open and laparoscopic surgical skils, as well as strong cancer training from a 6 year residency at Indiana University, I had the fortune of being the person.
We did 2 cases in Dec, 2004 (both prostates). We did between 1 (Feb 05) and 7 cases per month from Jan to Sep 0f 2005 for a total of 42 operations (including 32 prostates).
We then jumped to 13 operations (10 prostates) in Oct 2005 and should do about that many in Nov and Dec of 2005.
I project I will do 200 operations (150 prostates) in 2006.
robotic volume Nov 2005.jpg

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da Vinci hot shears

I use the da Vinci hot shears in my dominant (right) hand. I find it useful to take down adhesions from the sigmoid to the pelvis by cutting.
It provides excellent hemostasis by using cautery for the bladder neck or seminal vesicles, and is an excellent scissor to open the endopelvic fascia and to release the neurovascular bundle.
The only negative is the increased production of smoke that happens with this instrument compared to the hook.
For non-nerve sparing procedures, I still use the hook cautery.

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