Feb. 20, 2019
Robotic surgery has been performed for over 15 years at the Mayo Clinic. Its major application has been in radical prostatectomy; over 800 robot-assisted radical prostatectomies are now performed every year at Mayo Clinic's campus in Rochester, Minnesota.
Deepak K. Agarwal, M.D., a resident with Urology at Mayo Clinic in Rochester, Minnesota, says: "Since the advent of the robot, technical advancements in the procedure have been marginal. While the concept of single-port laparoscopic surgery has long held promise to diminish the morbidity of prostatectomy further, in practice it has not been met with widespread adoption due to the technical difficulty, nonuser-friendly interfaces and a steep learning curve leading to increased morbidity initially. However, Mayo Clinic has obtained two da Vinci SP robot-assisted surgical systems from Intuitive Surgical and is making this technology available to patients."
Left neurovascular bundle preservation
Left neurovascular bundle preservation
Left neurovascular bundle preservation guided by the da Vinci SP robot-assisted surgical system.
Apical dissection
Apical dissection
Apical dissection guided by the da Vinci SP robot-assisted surgical system.
Posterior bladder neck dissection
Posterior bladder neck dissection
Posterior bladder neck dissection guided by the da Vinci SP robot-assisted surgical system during Retzius-sparing single-port robotic prostatectomy.
A da Vinci SP robot-assisted surgical system
A da Vinci SP robot-assisted surgical system
A da Vinci SP robot-assisted surgical system in use at Mayo Clinic.
The da Vinci SP is a purpose-built, single-port robotic system that makes single-port surgery possible in a user-friendly manner. While three da Vinci SP prostatectomies have been reported in the literature, Mayo specialists have performed over 40 da Vinci SP prostatectomies at the Rochester campus, with favorable results.
"The da Vinci SP is a novel robotic system with four arms that deploy within the body from one 2.5-cm trocar, as opposed to four separate incisions for each arm with prior systems," says Vidit Sharma, M.D., a resident with Urology at Mayo Clinic in Rochester, Minnesota. "The prostatectomy also requires one bedside assistant port to allow for needle and suture passage intraoperatively compared with two with prior systems. Thus, this configuration decreases the number of incisions from six, for conventional robotic prostatectomies, to two."
At Mayo Clinic, the initial experience with the da Vinci SP robot-assisted surgical system has been favorable:
- In one surgeon's experience with five prostatectomies, procedure time has dropped below 150 minutes of skin-to-skin operative time.
- Median blood loss has been about 150 cc per patient.
- Over 95 percent of patients left the hospital the next day, and none required prolonged catheter placement.
- No major complications occurred.
Mayo specialists find that the system provides a unique benefit in select clinical situations over the conventional four-arm da Vinci robotic systems. For instance:
- When there are significant abdominal adhesions, there is less need for adhesiolysis as the single robotic port can be placed away from the adhesions.
- Intraoperative margins can be assessed during surgery due to the larger single incision, which was previously only possible with open radical prostatectomy.
- Given the increased maneuverability of the novel camera, the camera angle can change without the need to exchange lenses.
The camera's maneuverability also enables specialists to perform the completely posterior-approach, or Retzius-sparing, prostatectomy. Four Retzius-sparing single-port robotic prostatectomies have been performed at Mayo Clinic in Rochester, Minnesota. All four patients were continent within hours of catheter removal.
Due to the novelty of this technology, there is little published data on patient outcomes, patient-assessed outcomes and comparison to existing robotic platforms (Si and Xi). As a leader in robotic surgery, Mayo Clinic urology specialists are continuing to study this new technology to determine its role in the armamentarium of prostate cancer treatments.