First Live Robotic Kidney Removal Surgery at the AUA

I was honored to be chosen by Intuitive Surgical to perform the first live robotic kidney removal surgery at this years American Urologic Association conference (press release). This was the second year in a row that I have been chosen to perform l a live surgery.
Intuitive has been broadcasting live surgeries for 3 years now. I was one of 3 surgeons to perform a dvP (robotic prostatectomy) at the 2006 AUA convention. This year there were 4 live dvPs and my nephrectomy.

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Robotic Prostate Surgery- 1st quarter update

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The 1st quarter of 2007 was my busiest for da Vinci Prostatectomies (dvP) for prostate cancer (52 operations), as well as my busiest total robotic surgery 3 month period (60 operations).
My dvP volume increased 63% from the previous year and 24% from the previous quarter, which was then a record.
My total robotic surgery volume increased 50% from the previous year and 15% from the previous quarter, which was then a record as well.

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Delivery of the Median Lobe: A novel way to perform one of the most difficult parts of the dvP

This is my first technique that I will be adding to a new section of the blog.
After watching many videos and trying different ways to approach an intravesical median lobe, I found a new way to take care of it.
The following video was uploaded to google video and shows the dissection of a median lobe.

In simple terms: The bladder holds the urine and then the urine passes through the prostate on its way out. The prostate needs to be removed completely in prostate cancer surgery. The prostate is separated from the bladder routinely during the operation.
The median lobe is the part of the prostate that sometimes pushes into the bladder. This is the main reason why some urologists elect to place scopes into peoples bladders prior to surgery. This is one of the most difficult parts of the operation for beginners and experienced surgeons. The video shows the prostate (yellow) being separated from the bladder (green). The stitch is placed into part of the prostate to lift it off of the bladder.
Instruments used: PK dissector (bipolar), hot shears (monopolar- setting coag only 30), 2 needle drivers
Suture: 2’0 vicryl on an SH needle. (I have used 0’vicryl on a CT-1 for larger median lobes)
Color scheme- Yellow- Prostate; Green bladder and bladder opening; Orange arrrow- foley

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Dr. Savatta’s personal blog

Thoughts from a robotic surgeon

I have started this blog to express some of my personal thoughts.
I started the robotic surgery blog (http://www.roboticsurgeryblog/) 16 months ago and will still write there along with several other robotic surgeons.
I wanted a forum that I could share my more personal thoughts, some maybe controversial or personal.
I also wanted a place to put my patient’s testimonials and letters that was separate from the robotic surgery blog.
I also like blogger for quick-posting and to link easily to other blogger blogs.

After blogging for almost a year and a half here, I wanted a forum to express some of my thoughts that are not robotically based.
I started with an entry on where my patients have travelled from for minimally invasive surgery: 4 continents, 6 countries, and 10 states.

Robotic Surgery Update- February 2007 with a focus on robotic times

This is the monthly report on my robotic surgery practice in West Orange, NJ.
It was a relatively slow month. I performed 11 dvPs, and no other robotic surgery.
The main reason was a prostate conference/ vacation that I took. I went away for 7 days and did not schedule any surgery the week I was going away, so I was restricted to 2 1/2 weeks of surgery.
I had 1 important development. I developed a new technique for large median lobes that I am in the process of submitting to a journal. I think this technique will be the preferred way to approach large median lobes.
I also presented an important poster at the Prostate Cancer Symposium (a multidisciplinary international prostate cancer meeting), which I will write about later.

Click on picture to enlarge

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Prostate cancer in NJ

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This is the monthly update of my robotic surgery practice at Newark Beth Israel Medical Center. This months focus is on prostate cancer, with a record 24 dvPS performed this month.
This month I performed 27 robotic surgeries including 24 da Vinci prostatectomies for prostate cancer. Both of these are a record for 1 month in my practice and I had several important firsts.
I performed my first combo major robotic operation on a gentleman who was found to have a UPJ obstruction when he had a metastatic evaluation for prostate cancer. I performed a dvP and a robotic pyeloplasty at the same setting using the same 6 ports I would use for a dvP. The most amazing part of the operation is that each operation took less than an hour (the dvP was a record 46 minutes) and the patient still went home the following day.
I performed my first few dvPs in under 1 hour. Although time is not an important factor, these cases were still done very carefully. My feeling that these cases could not be done quickly with still perfect technique was wrong. With increasing experience for myself, as well as my assistant and nursing team, our times have dropped significantly. Our longest operation was in excess of 3 hours still since some dissections take much more time depending on the anatomy.
I also performed a robotic simple prostatectomy which was the first one under 2 hours.

Robotic Surgery Growth: November 2006

November 2006 robotic breakdown
For November I performed 21 robotic operations: 15 robotic prostate removals (dvP), 2 removals of a part of a kidney (robotic simple nephrectomy), 1 kidney (robotic nephrectomy), 2 removals of parts of a prostate for BPH (simple prostatectomy), and 1 reconstruction.
This was the 1st month that I performed 20 robotic surgeries.
The operations of note were:
The removal of a 27 cm kidney tumor. I think this was the record for largest kidney removed by a robotic system. This was for a benign tumor.
2 robotic simple prostatectomies for BPH. One was done with a new intravesical technique and also had many bladder stones removed.
The other was our 2nd largest prostate.
We removed our first prostate over 100 gms in less than 2 hours (122 gms in 100 minutes). I have developed a new technique for these large prostates that is less traumatic on the bladder and quicker than the usual way. We did a record 200 gram prostate in December using the same technique.

5 basic questions to ask your robotic surgeon

Robotic Prostate Surgery – What Men Need To Know
I came across this article on the web and can answer this for my practice:
“If you are considering robotic prostate surgery over traditional open surgery, you should make the following questions part of your doctor-screening process:

* How long have you been performing prostate surgery in general?”
I have been in private practice since July of 2003 and trained at Indiana University for urology for 6 years. The bulk of my prostate surgery started in 1999 as a urology resident.
“* How long have you been using the da Vinci robot?”

My first operation with the 4-arm standard was in December of 2004 and with the daVinci S, March of 2006.

“* How many of these surgeries do you perform each year?”
I performed 60 robotic prostatectomies in 2005 (80 total robotic operations) and should perform about 140 in 2006 (175 total operations). I keep a monthly update on this blog.
“* What is your overall success rate with robotic surgery?”
I keep statistics on my personal website, roboticcancer.com
“* Are there any unique considerations to robotic surgery as compared to open surgery?”
There are a few, but the only real negative once you have learned and understand the technology well is the loss of feedback. This is counteracted by a 10 times magnification of the anatomy at about 2-3 inches away as opposed to in open surgery, where we can magnify the anatomy 2.5 times with loupes at about a foot away. I believe this gives a picture that is about 20 times better for robotic than open.

Fortunately I have developed techniques that has allowed robotic surgery even in patients with previous surgeries, very large prostate up to 200 grams so far, and in obese patients (up to a BMI of 43 so far).

Haptics in the news

“It always helps to be able to feel what you are doing, to feel the tissue
tension and to feel the force when manipulating a suture,” says Domenico
Savatta, chief of minimally invasive and robotic urology surgery at Newark
Beth Israel Medical Center. “Haptics would make it easier to learn robotic
surgery, operate on things that are very delicate, and be an overall
advantage to have in the system.”

Source:
href=”http://www.technologyreview.com/BioTech/17909/”>Technology Review:
Surgical Robots Get a Sense of Touch

This was a nice review in technology review, by Brittany Sauser.
I appreciate the chance to stress the importance of what haptics will mean to robotic surgery.
Currently I have learned to rely on a highly magnified image and what I call, “visual haptics”. Having a 10 times magnified image with a camera that is a few inches away from the surgical field allows me to see the tension in tissue. I await the day when I can combine the visual haptics with touch.
I learned from this article that the team at John Hopkins is working on a visual haptic system that has dots that can change colors as a marker of tension.
I remember reading about a system that worked on auditory haptics, where a sound would increase in intensity with increasing tension.

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