When Mo Borghei was facing surgery for the removal of his cancerous prostate at age 62, he looked at all the options. “I did a lot of research on the Internet and discussed it with my son, who is a doctor. I then met with three doctors before I chose Dr. S. Adam Ramin,” he explains. “I was convinced that the da Vinci robotic procedure Dr. Ramin performs was my best choice.”
Dr. Ramin, a urological surgeon at Saint John’s Health Center, performed the first prostatectomy using the da Vinci minimally invasive, robotic-assisted surgical procedure at Saint John’s. He has been using the highly technical da Vinci procedure for over six years and has performed over 500 procedures. It is recommended that urologic surgeons trained in oncologic surgery, with extensive laparoscopic and robotic surgical experience, perform these procedures and to have done at least 200 of these procedures.
The da Vinci Robotic Prostatectomy and Pelvic Lymph Node Dissection procedure allows for the entire operation to be performed through very small skin incisions. Then a small telescope is placed into the abdomen through the belly button and pencil thin instruments are introduced,” says Dr. Ramin. “There are some terrific benefits for patients like Mo since there is faster recovery and little pain since open surgery is avoided. This translates to an excellent cure rate.”
Patients usually stay 1 to 2 days in the hospital, followed by 2-3 weeks of recovery at home before resuming all normal activities. Many patients return to work and sports activities such as running, weight lifting, golf, and tennis within two weeks after surgery. This is something that Mo can attest to: “Within a week after surgery, I was working part-time and working fulltime within three weeks. I definitely recommend this. It’s a life saver.”
The da Vinci procedure is a computer enhanced surgical system comprised of two components, robotic arms that hold the pencil thin surgical instruments, and a surgeon’s console that controls the robotic arms. The robot’s surgical instruments move to the direction of the surgeon’s hands, while the surgeon views the operative field through a 3-D TV screen. The tips of these tiny instruments have six degrees of freedom, allowing for movements like a tiny wrist around the prostate. “Because the instruments move like your wrist it is so precise and you can move around organs with greater ease,” explains Dr. Ramin. “Non-robotic surgical instruments used in open or laparoscopic surgery cannot move in this manner and do not have this degree of range of motion and flexibility.”
The highly magnified 3-D viewing screen allows the surgeon to feel “immersed” within the patient, thereby aiding in the differentiation between healthy and diseased tissue. In effect the surgeon accurately removes the prostate and pelvic lymph nodes, while preserving the vital structures such as the neurovascular bundles responsible for erections and pelvic floor muscles responsible for quick recovery of bladder control.
There is relatively much less chance of bleeding complications with the da Vinci Prostatectomy. There is also minimal blood loss and is an excellent choice for those who want to avoid the need for transfusion. “With the da Vinci procedure less than one percent need a transfusion vs. five percent for other procedures,” Dr. Ramin says.
Men in the early stages of prostate cancer with at least a ten-year life expectancy are excellent candidates for the da Vinci procedure. Men with locally advanced cancers or highly aggressive cancers are also candidates if the adjacent tissue is not involved. And patients who have gone through chemotherapy with little to no results should also consider this. “Some urologists would argue that surgery results in the highest chance of cure from prostate cancer,” Dr. Ramin explains. “And, the patient will know if he is cancer free within a month after surgery, as opposed to up to two years after radiation. That’s a big plus.”