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"BENEFITS OF LAPAROSCOPIC SURGERY"
VIDEO:
Bryn Mawr Urologist Dr. McGinnis Introduces Robotic "Assistant" in Surgery for Prostate
New Minimally Invasive Procedure
Produces Less Pain, Faster Recovery |
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VOICE ACTIVATED ROBOT CALLED AESOP
3 SMALL HOLES - FAST RECOVERY & LESS PAIN
FAQ: kidney, prostate, bladder surgery Information
Bryn Mawr Urology now brings the surgical system which performs remote telerobotic surgery.
to position an endoscope to give him a better view of the prostate during surgery. Dr. McGinnis is among the first in the Philadelphia region to remove cancer from the prostate through a minimally invasive procedure called laparoscopic radical prostatectomy.
According to Dr. McGinnis, a current standard treatment for prostate cancer is radical prostatectomy, in which an eight-inch incision is made in the patient’s lower abdomen to remove the prostate. “The clear advantages of performing this procedure laparoscopically are decreased pain, quicker recovery and less bleeding,” he explained. “The future of surgery is to become less invasive and limit the side-effects of treatment, and this is a big step in that direction.” |
*Dr. McGinnis was among the first urologists in the United States to perform laparoscopic radical prostatectomy in Pennsylvania. He studied laparoscopic radical prostatectomy and was taught by the Originators of Laparoscopic Prostate Surgery at the Institute Mutualiste Montsouris in Paris, France. Dr. McGinnis performs more daVinci Robotic Prostatectomies annually than any other urologist in Pennsylvania.
Bryn Mawr Urology now brings the da Vinci robotic surgical system which performs remote telerobotic surgery.
Highlights from Bryn Mawr Hospital's First da Vinci Prostatectomy... pictures of Dr. McGinnis and his team performing this procedure!
The da Vinci system consists of three components:
- a surgeon console with an integrated three-dimensional display stereo viewer
- a robotic manipulator with three cartmounted arms (one arm for the camera, two arms for the 8 mm instruments)
- vision cart
Visualization is obtained by two three chip cameras mounted within one integrated, three-dimensional 12 mm stereo endoscope with two separate optical channels. The laparoscope is controlled by moving the master robotic handles. The operative images are transmitted to a high resolution binocular display at the surgeon console. Unique laparoscopic instrument tips, called "Endo wrist instruments", provide articulated motion with a full seven degrees of freedom inside the abdominal cavity. Tip articular mimic the up/down ("PITCH") and the side-to-side ("YAW") flexibility of the human wrist. Instrument tips are aligned with the instrument controllers electronically to provide optimal hand-eye orientation and natural operative capability.
ABC Channel 6 NEWS - AESOP SURGERY ROBOT 9/22/2002
A local doctor is getting help from a robot named AESOP in making prostate surgery less invasive, and with an easier recovery. AESOP provides a highly magnified view of the surgery location. It's been around for several years, used largely for heart operations. Dr. David McGinnis of Bryn Mawr hospital says it also improves prostate surgery. One advantage is the use of small pencil-sized incisions, instead of the routine 8-inch cut. However, there are several others.
Dr. David McGinnis Bryn Mawr Hospital: "It doesn't tie up another person, and it's voice activated, so I just give it a command to move and do what I want. It gives a very steady shot, because robots, unlike people, don't have a tremor. So that steady image makes is much easier to watch the image on the TV screen while you're performing laparoscopic surgery."
The technology helped musician Joe Smith get back to his performance schedule faster. Joe Smith prostate patient: "I was allowed to go home the next day, and the recovery was very rapid." Dr. McGinnis believes we'll see smaller & smaller incisions, and more robots in future operations of all types.
To perform the laparoscopic procedure, a small camera, called an endoscope, is inserted into the patient’s abdomen to allow the surgeon to view the prostate on a video monitor during the surgery. A unique aspect of the procedure is that Dr. McGinnis uses robotic technology to assist him in positioning the endoscope to view the prostate. The robotic arm responds to the surgeon’s simple voice commands.
“The robotic arm gives surgeons a better view of the operating site and allows the assistant surgeon to use both hands to help the surgeon,” explains Dr. McGinnis. “We have found that patients are back to normal activities in two weeks and feeling much better than those who have had open surgery.”
Dr. McGinnis said patients who would not be good candidates for the minimally invasive procedure are those with prior prostate cancer treatment, including hormonal therapy and radiation therapy, and obese patients.
Manufactured by Computer Motion, Inc., a leader in medical robotics, the AESOP 3000 robotic technology is the first United States Food and Drug Administration approved surgical robot.
After lung cancer, prostate cancer is the second leading cause of cancer death among men in the United States. On an annual basis approximately 45,000 surgical procedures are performed to remove the cancerous prostate.
Dr. McGinnis received his bachelors degree, cum laude, from Harvard College, Cambridge, Massachusetts and his medical degree from the University of Texas Health Science Center at San Antonio, Texas. He served both his general surgery and urology residencies at Thomas Jefferson University Hospital, in Philadelphia, Pennsylvania. He was awarded a Fellowship in Minimally Invasive Urologic Oncology from 1999 to 2000.
David McGinnis, MD, a Bryn Mawr Hospital urologist, is among the first in the Philadelphia region to remove cancer from the prostate through a minimally invasive procedure called laparoscopic radical prostatectomy.
David McGinnis, MD, a Bryn Mawr Hospital urologist, is among the first in the Philadelphia region to remove cancer from the prostate through a minimally invasive procedure called laparoscopic radical prostatectomy.
Only a few centers nationwide are currently performing this procedure. For patients undergoing laparoscopic procedures, there is less pain and quicker recovery than following conventional surgery. Kidney cancer tends to affect both men and women almost equally and tends to affect people in their 40's to 80's with the greatest incidence affecting people in their 60's. Minimally invasive surgery can remove a cancerous kidney just as effectively as traditional open surgery while giving adults, children and infants patients the same long-term survival. The symptoms of kidney cancer typically are a pain in the flank or upper side of your back that doesn't go away, a feeling of poor health, blood in the urine and in some cases, a mass you can feel in the flank.
NEW: Patients will have three small incisions in their side below their ribs for the procedure. The procedure generally takes just between three and four hours and the patient can expect to have a hospital stay of one to two days.
OLD: The old way might find four half-inch incisions in the abdomen, along with one three inch incision near the navel rather than the conventional, 12- to 14-inch incision. A laparoscope is inserted, allowing surgeons to extract the kidney without having to remove part of a rib or make the very large, tissue-cutting incision required with the surgery in the past. As a result, donors can leave the hospital in three days and return to work in about 16 days.
Laparoscopic Procedure for Prostate Cancer Results in Faster Recovery for Patients - Bryn Mawr Urologist Enhances Procedure with Robotic Technology
(BRYN MAWR, PA) David McGinnis, MD, a Bryn Mawr Hospital urologist, is among the first in the Philadelphia region to remove cancer from the prostate through a minimally invasive procedure called laparoscopic radical prostatectomy. Only a few centers nation-wide are currently performing this procedure. For patients undergoing laparoscopic procedures, there is less pain and quicker recovery than following conventional surgery.
According to Dr. McGinnis, a current standard treatment for prostate cancer is radical prostatectomy, in which an eight-inch incision is made in the patient's lower abdomen to remove the prostate. "The clear advantages of performing this procedure laparoscopically are decreased pain, quicker recovery and less bleeding," he explained. "The future of surgery is to become less invasive and limit the side-effects of treatment, and this is a big step in that direction."
To perform the laparoscopic procedure, a small camera, called an endoscope, is inserted into the patient's abdomen to allow the surgeon to view the prostate on a video monitor during the surgery.
A unique aspect of the procedure is that Dr. McGinnis uses robotic technology to assist him in positioning the endoscope to view the prostate. The robotic arm responds to the surgeon's simple voice commands.
"The robotic arm gives surgeons a better view of the operating site and allows the assistant surgeon to use both hands to help the surgeon," explains Dr. McGinnis. "We have found that patients are back to normal activities in two weeks and feeling much better than those who have had open surgery."
Dr. McGinnis said patients who would not be good candidates for the minimally invasive procedure are those with prior prostate cancer treatment, including hormonal therapy and radiation therapy, and obese patients.
Manufactured by Computer Motion, Inc., a leader in medical robotics, the AESOP 3000 robotic technology is the first United States Food and Drug Administration approved surgical robot.
After lung cancer, prostate cancer is the second leading cause of cancer death among men in the United States. On an annual basis approximately 45,000 surgical procedures are performed to remove the cancerous prostate.
Bryn Mawr Hospital Surgeon Combines Advanced Minimally Invasive Procedure And Robotic Technology to Treat Prostate Cancer
PR Newswire, Sept 17, 2002 BRYN MAWR, Pa. -- Bryn Mawr Hospital surgeon David McGinnis, MD, is changing the way prostate cancer is being treated, using a robot called "AESOP." Dr. McGinnis is among the first urologists in the United States to use robotic technology to enhance his minimally invasive surgical techniques.
Dr. McGinnis has been performing the robotically assisted Laparoscopic Radical Prostatectomy, or LRP, at Bryn Mawr Hospital since last year. He studied LRP at the Institute Mutualiste Montsouris in Paris, France with Drs. Guy Vallancien and Bertrand Guillonneau. He is among the first American urologists to implement the procedure in this country, and has performed more than 40 procedures to date. The new procedure dramatically reduces recovery time for patients, and Bryn Mawr is one of only about 20 medical centers in the country to offer the new surgery. Manufactured by Computer Motion, Inc. , a leader in medical robotics, the AESOP robotic technology is the first United States Food and Drug Administration approved surgical robot.
According to Dr. McGinnis, a current standard treatment for prostate cancer is radical prostatectomy, in which an eight-inch incision is made in the patient's lower abdomen to remove the prostate. "The clear advantages of performing this procedure laparoscopically are decreased pain, quicker recovery and less bleeding," he explained. "The future of surgery is to become less invasive and limit the side-effects of treatment, and this is a big step in that direction."
To perform the laparoscopic procedure, a small camera, called an endoscope, is inserted into the patient's abdomen to allow the surgeon to view the prostate on a video monitor during the surgery.
A unique aspect of the procedure is that Dr. McGinnis uses robotic technology to assist him in positioning the endoscope to view the prostate. The robotic arm responds to the surgeon's simple voice commands. "The robotic arm gives surgeons a better view of the operating site and allows the assistant surgeon to use both hands to help the surgeon," explains Dr. McGinnis. "We have found that patients are back to normal activities in two weeks and feeling much better than those who have had open surgery."
Dr. McGinnis said patients who would not be good candidates for the minimally invasive procedure are those with prior prostate cancer treatment, including hormonal therapy and radiation therapy, and obese patients. After lung cancer, prostate cancer is the second leading cause of cancer death among men in the United States. On an annual basis approximately 45,000 surgical procedures are performed to remove the cancerous prostate.
A Less Invasive Surgery for Prostrate Cancer PDF
The AESOP robotic arm is the first surgical robot approved by the US Food and Drug Administration. Dr. McGinnis, is a graduate of Harvard College (1982) and the University of Texas Health Sciences Center, San Antonio (1987). He served an internship and residency at Thomas Jefferson University Hospital, and is a faculty member at Jefferson Medical College.
What Are the Different Types of Prostate Cancer Surgery?
Retropubic prostatectomy: During this procedure, the surgeon makes an incision through the lower abdomen that is about 3 to 4 inches in length. The surgeon can remove the prostate, surrounding tissue and pelvic lymph nodes (if necessary).
Perineal prostatectomy: During this procedure, the surgeon removes the prostate through an incision in the skin between the scrotum and the anus. In general, the perineal surgery is a little easier on the patient, but it may be somewhat inefficient if the cancer is serious and the lymph nodes need to be examined before the prostate is removed.
Laparoscopic prostatectomy is a type of 'minimally-invasive' surgery that uses several small incisions rather than one larger incision to remove the prostate. Through the small incisions surgical instruments, including a camera, are inserted. The camera allows the surgeon to view inside the abdomen and perform the surgery. Because the surgery uses smaller incisions, the patient may experience less pain and scarring and a faster recovery than with the retropubic approach. This procedure is technically demanding and requires a surgeon with special training to perform the operation successfully.
Robotic-assisted laparoscopic prostatectomy is similar to laparoscopic prostatectomy but rather than the surgeon directly holding the instruments, a robot serves as an interface between the surgeon and the instruments. Advantages for the patient are similar to laparoscopic surgery.
What Can be Expected After Surgical Treatment?
At the time of surgery, the urinary tract is sutured back together over a catheter, a thin flexible tube to drain urine. This gives the anastomosis, or union between the bladder and the urethra, time to heal completely. The catheter will remain in place for one to two weeks after the surgery. The catheter is removed on a return visit to the surgeon's clinic, and exercises (called Kegel exercises) are begun by the patient to strengthen the urinary control valve. Urinary control (continence) can be immediate but usually takes several weeks to months to recover.
One or two suction drains are left beside the bladder, deep in the pelvic cavity, to drain any fluid that accumulates. The drains will exit from a small incision in your lower abdomen (or pelvic area). They help to decrease the risk of infection and pressure from fluid in the operated area. The drains are usually removed before you are discharged from the hospital.
While in the hospital, the patient begins his physical recovery. After the operation you will be in the Post-Anesthesia Care Unit (PACU) for a recovery period of several hours. You can have ice chips and water as soon as you are fully awake. Family members may also visit you in the PACU. You will be taken to your hospital room after the recovery period.
Fluids will be given to you through an intravenous (IV) line in a vein. The IV line will remain in place until you can tolerate fluids and food by mouth and you begin to eat a regular diet. You can progress to a clear liquid diet that evening or the next morning after the surgery. When your intestinal activity begins to recover, about 24 - 36 hours after the operation, you can eat solid food. Most people do not pass flatus (intestinal gas) for one to two days and do not have a bowel movement for four to five days. The goal during the first few days after your operation will be to prevent the breathing and circulation problems that can develop after any surgery. You must walk at least three to four times a day to help your breathing and circulation.
After the surgery, the surgeon reviews the final assessment of the removed prostate and (if applicable) the lymph nodes. Based on this "final pathology," a follow-up plan is developed. If the pathology is especially serious (e.g., spread to the seminal vesicles or lymph nodes) additional therapy may be recommended. This may include radiation therapy and/or hormone treatment. If the pathology is not especially serious, the follow-up plan entails regular visits to a physician and a regular PSA test. The PSA level should be non-detectable.
Erectile function may recover soon after the operation or may take up to one year to return. Usually, if erections are not sufficient for intercourse at one month, additional therapies are used until the erections become sufficient. One does not lose the ability to have an orgasm. However the orgasm is "dry"—very little (if any) ejaculation comes out—so the ability to procreate is generally lost. |
