COLUMBUS, Ohio – Physicians at The Ohio State University’s Arthur G. James Cancer Hospital and Richard J. Solove Research Institute are turning to an unlikely source for help in the delicate processes involved in bladder cancer surgery: a refrigerator-sized robot with arms of steel.
Robots are frequent partners in prostate cancer surgery at Ohio State, but a new procedure this month marks the first time clinicians here have used one to perform a radical cystectomy, or removal of the bladder.
Dr. Vipul Patel, director of robotic and minimally invasive urologic surgery at Ohio State, says a robot offers patients the advantage of tiny, computer-directed instruments that enable the precise and delicate suturing a cystectomy requires. He says it’s easier on surgeons, too, because it relieves the stress of standing long hours at the operating table, and offers a clearer, magnified image of the surgical site.
That may be beneficial for the 63,000 people in the country who are expected to develop bladder cancer this year. Not everyone who is diagnosed with the disease will need extensive surgery - if detected in its earliest stages, bladder cancer is treated simply by slipping a slender tube up through the urethra and “scooping” out any malignant growth, a process that’s often followed by laser treatment or burning the base of the tumor to get rid of any cancer cells that might have been missed.
But if the cancer has advanced into surrounding tissue – and Patel says that’s the case in about a third of all cases – then the entire bladder must come out. Under the older, traditional method, a cystectomy would typically take two to four hours. The surgeon would stand and operate at the table, initially making a large incision that could lead to the loss of up to two liters of blood. In men, a cystectomy also involves removal of the prostate gland; in women, it also means taking out the uterus and a part of the vagina. It is major surgery, often requiring up to a week of recovery time in the hospital.
In contrast, Patel says a robotic-assisted laparoscopic approach is easier for both the patient and the surgeon. Using robotics, the surgeon sits at a console near the patient and accesses the surgical site using robotic “arms” tipped with computer-guided, miniaturized instruments. “The robot has several centimeter-sized instruments that can turn and twist in exactly the same way your hands can, and it means we can get into small spaces, suture and tie much more precisely,” says Patel.
Patel says robotic-assisted processes cut surgical time in half, involve much less blood loss and rarely require transfusions. The patient is often up and about within a day or two because the surgery is accomplished with a just few keyhole-sized incisions and miniaturized instruments, rather than a major incision in the abdomen.
Patel, who has taught robotic surgery around the world, says robots are being increasingly used in an expanding menu of surgical options. He notes that its less-invasive process also opens the door to surgery for people who might not otherwise have been candidates for surgery in the past – patients who object to blood transfusions on religious grounds, for example, or others who have previously existing heart or lung problems.
According to the American Cancer Society, the incidence of bladder cancer has remained stable over the past decade, although men are four times more likely to develop it than women. Smoking remains the greatest risk factor for the disease, with smokers developing bladder cancer twice as often as non-smokers. When detected early, bladder cancer is often curable, but among patients with advanced disease at diagnosis, only 5 to 10 percent live longer than five years.
The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute is one of the nation’s leading centers for research on the prevention, detection, diagnosis and treatment of cancer. The OSU CCC-James encompasses six interdisciplinary research programs and includes more than 200 investigators who generate over $100 million annually in external funding. OSU James, a founding member of the National Comprehensive Cancer Network, is ranked by U.S. News & World Report as one of America’s best cancer hospitals.# # #
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