Laparoscopic radical prostatectomy with a remote controlled robot

Purpose: Robotics in surgery is a recent innovation. This technology offers a number of attractive features in laparoscopy. It overcomes the difficult ies with fixed port sites by restoring all 6 degrees of freedom at the inst rument tips, provides new possibilities for miniaturization of surgical tas ks and allows remote controlled surgery. We investigated the applicability of remote controlled robotic surgery to laparoscopic radical prostatectomy. Materials and Methods: Our previous experience with laparoscopic prostatect omy served as a basis for adapting robotic surgery to this procedure. A sur geon at a different location who activated the tele-manipulators of the da Vinci* robotic system performed all steps of the intervention. A scrub nurs e and second surgeon who stood at patient side had limited roles to port; a nd instrument placement, exposure of the operative field, assistance in hem ostasis and removal of the operative specimen. Our patient was a 63-year-ol d man presenting with a T1c tumor discovered on 1 positive sextant biopsy w ith a 3+3 Gleason score and 7 ng./ml. preoperative serum prostate specific antigen. Results: The robot provided an ergonomic surgical environment and remarkabl e dexterity enhancement. Operating time was 420 minutes, and the hospital s tay lasted 4 days. The bladder catheter was removed 3 days postoperatively, and 1 week later the patient was fully continent. Pathological examination showed a pT3a tumor with negative margins. Conclusions: Robotically assisted laparoscopic radical prostatectomy is fea sible. This new technology enhances surgical dexterity. Further development s in this field may have new applications in laparoscopic tele-surgery.