The robot is in: New surgical technique helps cancer patients

On a TV screen in an operating room, tiny pincers deep inside an abdomen separate a bundle of nerves and blood vessels from a red ball of flesh. Scissors smaller than a fingernail cut an artery and immediately cauterize it with a puff of smoke. Not a drop of blood spills.

The doctor - seated and peering into a video monitor across the room from the patient - uses remote-controlled instruments to pull out the meatball-sized prostate and stuff it into a plastic bag for lab examination.

He then goes to work reconnecting the urethra and crucial nerves and arteries. The surgery is over in a couple of hours - and the surgeon never touched the patient with his own gloved hands.

Doctors at Central DuPage Hospital, where this surgery was performed, are on the leading edge of a revolution in surgery.

The use of a robot to remove prostates has in many cases transformed the procedure from a painful, debilitating surgery to one in which patients are up and walking the same day.

For the first time this year, robotic prostatectomies are expected to become the most common way of removing the prostate. It's a potentially lifesaving procedure that can determine whether patients can control their bladders or have sex again.

The robot, known as the da Vinci Surgical System, is increasingly being used in leading hospitals throughout Chicago and the suburbs not only for prostatectomies, but for other delicate procedures such as hysterectomies and heart surgery.

Some doctors have objections about the procedure, preferring hands-on old-school operations. Cost is also a significant factor, with the da Vinci system running $1.5 million, plus annual upkeep of $140,000.

But many patients who've undergone the robotic procedure - such as Glen Ellyn resident Joe Hasiewicz - wouldn't have had it done any other way.

For a song

Four years ago, Hasiewicz, a software architect and composer, took a blood test that found elevated levels of PSA, the prostate specific antigen that's a potential sign of prostate cancer. A biopsy found cancer.

He investigated alternatives: freezing the prostate, implanting radioactive pellets, chemical castration, or doing nothing and waiting to see if the cancer would grow.

Because he was only 45, married and a father of three, he felt it best to remove the cancer.

A friend and bandmate had had traditional "open" prostate removal, which involves an 8- to 10-inch incision so the surgeon can get hands to work inside the body. After that, his friend was out of work for a month recovering.

Like many men, Hasiewicz' biggest concerns were: "Am I going to be peeing in my pants? Am I going to have sex again? And, I've got cancer, I could die. It was a dark and scary time."

Dr. James Giblin told Hasiewicz he could preserve more of his nerves in the area by using the da Vinci robot. As a believer in advanced technology, Hasiewicz chose the new procedure. The next day, he was walking and eating and out of the hospital.

In a few weeks, he was able to have sex, and he soon had control of his bladder again.

He wrote a song about the experience, "Repairing the Ordinary Day," and posted it on his Web site at joehasiewicz.com.

Asked for his advice for other men in his position, Hasiewicz said, "I hope this gives them hope. When you get hit with cancer, you're like, 'Oh @#%! I'm gonna die', but that's not always the case. If it's caught early, you can put all that stuff behind you."

Less pain, blood

Giblin had successfully performed traditional prostatectomies for years at Central DuPage in Winfield.

But he believes the da Vinci robotic surgery means less pain, less blood loss, fewer complications and faster recovery, and is as effective in removing cancer. Research supports those findings, though it's too early to tell if robotic surgery improves survival rates or recurrence.

The procedure uses laparoscopic surgery, meaning it involves about five inch-long incisions around the abdomen, through which are inserted surgical instruments and a tiny camera. Gas is blown into the abdomen to make room to see and maneuver.

While traditional laparoscopic instruments are fixed, like a marshmallow fork, the da Vinci instruments use patented instruments that rotate like the human wrist. That, plus a three-dimensional camera view that magnifies the view 10 times, gives the surgeon a great advantage, Giblin says.

Some surgeons prefer the old-fashioned operation by hand, insisting they have a better feel for the tissue.

The procedure takes 15 to 30 surgeries to get the full feel for it, Giblin said, but now, he's a believer.

"Because of its increased precision and magnification," he said, "I believe I can do a better job."

Medical pioneers

Robotic surgery was initially developed with an eye toward using it remotely on the battlefield, but it's proved more practical in the operating room, and potentially as a remote teaching tool.

Since being approved for use by the federal government in 2000, more than 1,000 da Vinci systems are operating worldwide. The makers of the unit, Intuitive Surgical Inc., of Sunnyvale, Calif., earned $600 million in revenue last year, one-third of it profit.

The surgery is generally for healthy men under 70 whose cancer is believed to be confined to the prostate, an organ that produces seminal fluid and is located just in front of the rectum.

Overall, one in six men will be diagnosed with prostate cancer. Though it's a slow-growing disease with a five-year survival rate of 99 percent, 29,000 men will die from it this year.

In addition to prostate removal, robots are increasingly being used for other procedures, such as gastrointestinal repairs.

At University of Chicago Medical Center, Dr. Sudhir Srivastava is pioneering the use of the da Vinci for heart bypass operations without having to crack open the chest. He's performed some 850 robotic surgeries, more than anyone in the world.

In the suburbs, Dr. David Goldrath and Advocate Good Shepherd Hospital in Barrington have done more than 300 robotic surgeries.

At Advocate Lutheran General in Park Ridge, doctors recently used the da Vinci to remove a cancerous bladder from 80-year-old Rosemarie Grimm of Mount Prospect.

"You feel so much better sooner," her daughter, Claudia Brutt said. "She bounced back from it."

One big growth area for robotic surgery is kidney surgery, said Dr. Gordon Gluckman at Lutheran General. Because use of the robot is very dependent on the surgeon's familiarity with it, he advised seeking someone who has experience with it.

"I'm a believer," he said. "The robot is here to stay."