This is a monthly update on the growth of Robotic Surgery in my practice.
As I explained last month, I have been restricting use of the da vinci robot to prostate surgery. Until our second robot is operational on a regular basis, I have been mostly performing davinci prostatectomy (dvP) for prostate cancer.
In March, despite one week of vacation, I performed 13 robotic operations. One was an elderly gentleman who had a robotic cystoprostatectomy. The other 12 were dvPs. To date I have performed 121 robotic operations with 93 done for prostate cancer (77%).
The highlights for the month were:
12 robotic prostate cancer surgeries, the most in my practice for 1 month.
5 robotic prostates in 1 week, also the most for 1 week.
All 12 prostate cancer patients had negative margins on the pathology report, which makes 26 consecutive patients with negative margins (About 15% would be very good and anything under 10% is excellent). This should lead to excellent long term cancer control.
One patient had a problem that I have never seen before in my almost 100 dvPs or any of the open prostatectomies that I have performed. After doing well for several days, his urine stopped draining from the catheter. It seems that when the catheter settled at the connection site between the bladder and urethra, it made the urine drain preferentially out the connection and into the belly. This required a hospital stay and a small drain placed into the abdomen. This healed without further surgery, but required me to push the catheter away from the connection several times until I taped the catheter in a way that it would stay away from the connection.
The only thing that was unusual about his surgery was that his urinary drainage tubes (ureters) were placed very close to the bladder neck. Ive seen this several times before with robotics and never had this problem before.
This was the first major complication that we suffered in our robotic prostate series to date. I am glad to say that at his 1 month visit, he already had excellent urinary control. If other urologists ever have this problem, please contact me and we can discuss this rare complication.