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Using the da Vinci Robot for Prostatectomy

Mario Monteleone underwent robot-assisted prostate cancer surgery in August 2010 at SIUH.

Mario Monteleone's doctor had been tracking his PSA levels for six years. With each blood test, his level of prostate-specific antigen - a protein made by the body and used to help detect prostate cancer - varied.

If the number rose, antibiotics were prescribed, and the cause attributed to infection or inflammation in his prostate. Then, about four years ago, his levels continued to climb. A biopsy was done that came back normal.

In 2010, Monteleone's PSA level reached 10, meaning he was at an increased risk for prostate cancer.

A second biopsy was done that showed that the 66-year-old Great Kills man had cancer in 5 percent of his prostate.

His doctor recommended several treatment options: hormone therapy, external beam radiation or radioactive tumor seeding.

"I didn't want any of that," said the retired Wall Street securities specialist. "So, I looked at alternatives and I got opinions and more opinions."

After much thought, Monteleone chose to have a prostatectomy - surgical removal of the prostate gland - using robot-assisted technology recently available at Staten Island University Hospital.

In August 2010, Dr. Nicholas Karanikolas, director of Urologic Oncology at SIUH's Ocean Breeze campus, operated on Monteleone using the da Vinci Surgical System.

The high-tech surgery involved two components: a robot with spider-like arms equipped with a camera and tiny surgical instruments, and a separate console station located several feet away from the operating table where the surgeon controlled the robot's every movement.

Five half-inch incisions were made in Monteleone's abdomen through which the camera and instruments were passed.

During the prostatectomy, Dr. Karanikolas sat at the console looking into special binocular-enhanced lenses at a 3D image sent from the camera inside his patient's body. Aided by the magnified view, he used the console's control knobs, which resemble video game joysticks, to maneuver the grasping and cutting motions made by the da Vinci robot.

"We control the arms and the camera with the joysticks allowing us not only optimal visualization but manipulation of tissues in a very deep and intricate area of the body," said Dr. Karanikolas.

The ability to move the robotic arms in precise millimeter increments allowed him to remove Monteleone's prostate while preserving surrounding tissue and nerves responsible for urinary continence and sexual function.

The da Vinci robot enables surgeons to do minimally invasive procedures with smaller incisions, resulting in less bleeding and pain for the patient, shorter recovery times and fewer post-operative complications, such as incontinence and impotence, explained Dr. Karanikolas.

Following his surgery, Monteleone spent another day and a half at the hospital before being discharged. A catheter placed during the procedure was removed 10 days later.

"It took about a month or two to heal and after that, everything has been fine," said Monteleone, who prior to his surgery had difficulty urinating.

For the next two years, he will have to have his PSA level monitored every three months to check for cancer recurrence. Monteleone said he has no regrets about opting for the high-tech surgery.

"This is becoming the dominant means by which prostate cancer is being treated," said Dr. Karanikolas. "Presently, 85 to 90 percent of all prostates are being removed robotically and in the future, it may represent 95 to 99 percent."

Dr. Nicholas Karanikolas, director of Urologic Oncology at Staten Island University Hospital, demonstrates the robotic arms of the da Vinci Surgical System.

Categories: Minimally Invasive Surgery

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