WITNESS: A prostate cancer patient trusts in a robot
Douglas Hamilton has been a correspondent for Reuters for many years and is currently the Bureau Chief for the Balkans, based in Belgrade. In this story, he relates how a diagnosis of cancer led him to the United States for robotic surgery, a new procedure using advanced technology to save lives with less pain, fewer complications, and a better chance of a full return to normal.
By Douglas Hamilton
NEW YORK (Reuters) - Scary as it sounds, robotic surgery is taking a lot of the dread out of prostate cancer.
My experience of the 21st century treatment began at New York Presbyterian Hospital a few days into 2008, with an introduction by surgically masked Chip Berryhill.
"There's the robot, and over there is the console where Dr. Tewari will operate," he instructed casually, as I climbed onto a precariously narrow operating bench halfway between them.
Faintly menacing, the four-armed da Vinci machine stood against the wall, waiting to be moved into position once I had lost consciousness under the anesthetic.
Berryhill is physician assistant to Dr. Ash Tewari, who is recognized as one of the world's top practitioners of a procedure changing the face of modern medicine.
Prostate cancer is the second leading cancer killer for men, after lung cancer. A simple blood test now helps detect it, before it spreads. But eradication of the threat through surgery carries risks men dread -- incontinence and impotence.
"It's a tough call," admitted Prof. Wolfgang Aulitzky of Vienna's Confraternitaet clinic, after diagnosing my cancer in October. There were no symptoms, just a high score on the PSA (prostate specific antigen) blood test.
The test is not perfect. It may indicate cancer where there is none, or miss it where it exists. Men with high PSA and nerves of steel may chose to ignore it. Others have a biopsy.
Little cores are cut from the walnut-sized gland. Even if the biopsy does detect some evidence of cancer the procedure can miss aggressive tumors that kill quickly.
There are a range of treatments for the cancer. But given my biopsy results the doctors said the only real choice was decisive action.
"Radiotherapy to slow the cancer is an option for older men," said Aulitzky when he reviewed my biopsy results. "In a healthy man of 60 we go for longevity and that means radical prostatectomy to remove it."
I embarked on a frenzy of reading, then accepted the need to choose: risk surgery or risk early death.
For the prostate surgeon, the challenge lies in two fundamentally competing goals: eradicating the cancer while preserving to the maximum the patient's quality of life.
Classic "open" surgery has made huge advances over the past 40 years to reduce damage once accepted as the price of removing the threat. Helped by better scanning technology, surgeons can focus on sparing as much neurovascular tissue as they can.
Studies show robotic surgery gets even better results, shortening hospital time to one overnight and recovery to two weeks, with good prospects of a normal function in 6-7 weeks.
No human hand enters the body. The cancerous prostate is cut out using tiny, highly flexible instruments on the ends of steel probes inserted by the team through slits in the abdomen.
They are manipulated by the surgeon seated at the console a few feet away, peering into 3-D sights with variable lenses that offer close-ups from an internal camera.
The robot cannot be programmed or make decisions on its own. All depends on the skill and experience of the surgeon and his team, operating instruments without fingertip feel but with computerized tactile input and enhanced vision.
Hands-on, open prostatectomy makes an 8 inch incision from navel to pubic bone, needing 2-3 months to heal.
When I woke up, I had six half-inch incisions around my abdomen, covered with little strips of tape. I was walking -- stiff and sore, woozy but upright -- just six hours later.
Tewari performs the 90-120 minute operation 3 times a day, on patients from all over the world (www.theehealth.com).
Like colleagues at Henry Ford hospital's Vattikuti Urology Institute in Detroit, where Dr Mani Menon pioneered the surgery, he is constantly refining method and technique.
"I try not to touch the nerves at all," said Tewari, a warm man with a gentle manner.
He is, of course, limited by how far cancer has advanced. In 80 percent of cases he is able to perform maximum nerve-sparing, resulting in a return to continence for 97 percent of patients and sexual function for 87 percent, within 6 months.
A da Vinci robot costs about $1.2 million. There are already many practicing surgeons in the United States, but far fewer in western Europe (www.davincisurgery.com).
It is costly. Tewari team nurse Carol Celona jokes that "we're heading for drive-thru surgery in this country" to cut down on hospital time. But the price can still reach $45,000.
It is also, like any major surgery, not completely painless.
The catheter is the worst part. This plastic tube as thick as a cocktail straw is inserted in the urethra, via the penis, up into the bladder to bridge the gap where the prostate was.
For at least a week after surgery, until the re-attachment heals, urine runs freely into a plastic bag strapped to the leg of the patient, who is urged to drink a lot and walk a lot.
This is a challenge, and the catheter is a hated necessity.
"Well, we know that ," Tewari told me with a smile, after it was removed. "But we're working on it."
(Editing by Sean Maguire; email@example.com)
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