Wednesday, July 18, 2007

da was a genius

This week I observed the removal of a prostate that had been affected by cancer. The prostate is a gland that provides nutrients for the seminal fluid that leaves the seminal vesicles. It is located below the bladder and is also connected to the seminal vesicles. The urethra starts at the base of the bladder and runs through the prostate to the end of the penis. In the past, at NYPH, the patient's abdomen was cut open to remove the prostate, which is a relatively invasive procedure. Currently, at NYPH, a machine termed "da Vinci" is used to perform the operation. There are several benefits to this technique: 1) it is minimally invasive (as I will soon describe) 2) the patient can leave the next day and 3) there is a lot more accuracy where cuts are made. The main drawback of this technique is that it requires a large learning curve.

The da Vinci surgical system consists of two major components. The first component is comprised of three robotic arms (top image). The center arm is used to control the endoscope and the other two arms control the two instruments. The other major component is the control center (bottom image). For this procedure, 5 incision points are made in the abdomen of the patient. One incision point in made near the medial line of the body, which is where the endoscopic arm will be inserted. Two more incisions, one on each side of the middle incision, will be made for the two robotic arms that will control the surgical instruments. And two final incision points will be made on the abdominal sides, for two additional instruments used by the nurses to assist in the surgery. Below is an image of what whole procedure may look like.

Throughout the surgert, the doctor will sit at the control station and control the arms. It was truly an awesome sight to see the large robotic arms swaying around and hitting the assisting nurses as the instruments cut through the tissue. Below is a picture of what one of the tools may look like. The precision that the system allows is incredible. One of the main issues of the surgery is to not cut the nerve that may be responsible for sensation. This system allows the surgeon to clearly see what he/she is cutting.

In the end, the prostate is disconnected from the bladder, the seminal vesicles and vas deferens are clipped, and the urethra is reattached to the bladder. The man will obvioulsy not be able to have children, but if the surgery went well, he would still be able to have sensation in his penis and will still be able to have an orgasm, although there would be no ejaculation. Leonardo didn't design this system, but if he were still alive today, I know he would have.

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