The prostate and kidney cancer specialists. Robot-assisted surgery for prostate and kidney cancer

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1 The prostate and kidney cancer specialists Robot-assisted surgery for prostate and kidney cancer

2 ROBOT-ASSISTED SURGERY AT HARLEY STREET UROLOGY Mr Marc Laniado, Consultant Urologist Robot-assisted prostatectomy, also called da Vinci prostatectomy, is the treatment of first choice in America for early prostate cancer. It offers patients the benefits of high cancer cure rates, significantly reduced side-effects and rapid recovery. The same benefits are also evident for robot-assisted nephrectomy. Robot-assisted prostatectomy the da Vinci prostatectomy This procedure, first performed in 1999, is the established prostate cancer treatment of choice in America. However, in the UK, there are currently only a small number of centres with a da Vinci robot, and few specialists with extensive, long term experience of the da Vinci prostatectomy. Our experience Mr Laniado was one of the first surgeons to introduce the da Vinci prostatectomy in the UK. Together with his colleague, Mr Alan Doherty, our urologists have performed more than 1,400 prostatectomies, one of the largest UK caseloads. Robotassisted partial nephrectomy, or nephron-sparing surgery More patients are being diagnosed with early stage kidney cancer, as a result of improved diagnostics. These patients are suitable for a partial nephrectomy, preserving kidney function as far as possible. Robot-assisted partial nephrectomy was first performed in 2004 and a major study has recently shown the robot-assisted approach offers the best outcomes for patients. Our experience Mr Laniado was one of the first surgeons to introduce robotassisted kidney surgery in the UK. Mr Doherty is one of the UK s leading laparoscopic surgeons and has performed keyhole partial and full nephrectomy.

3 HOW DOES ROBOT-ASSISTED SURGERY WORK? The robot is made up of two units: 1 The first unit is on the patient side with four robotic arms. One arm holds a high magnification camera and the other three arms hold instruments. 2 The surgeon sits at the second unit, which is a console with a threedimensional, high definition view of the operating field. The operation takes place through four to six small incisions which are cm in size. Three or four robotic arms, which are 0.7 mm wide, are inserted and two other ports are used by an assistant. The hand movements of the surgeon are translated in real time movements by the robotic arms. The system is designed to remove any hand tremor and ensure very precise movements. The instruments have very natural movements, comparable to the human hand and are said to be wristed. The da Vinci prostatectomy Indications Recovery Reduced risk of long term erectile dysfunction and incontinence due to highly precise surgery Effectiveness Early, organ confined prostate cancer. If the urologist believes cancer cells may have spread beyond the prostate, an open prostatectomy will be indicated. The incisions made during a robotic prostatectomy are 0.5 1cm wide, compared with 10 15cm for open surgery. This means there is much reduced blood loss, scarring, bruising and risk of infection. Following da Vinci prostatectomy, there is typically a hospital stay of two days and return to normal activity within weeks. During the da Vinci prostatectomy, the surgical field is projected onto a 3D screen, where it is magnified fold. This high definition, enlarged view enables the surgeon to clearly visualise the blood vessels and nerves surrounding the prostate. These nerves control continence and erections and the traditional radical prostatectomy involved cutting and damaging these nerves while removing the prostate. The da Vinci prostatectomy aids nerve-sparing procedures surgery which safely removes all cancer cells but causes minimal damage to adjacent nerves. There is extensive evidence to show that for early, organconfined prostate cancer, da Vinci prostatectomy is as effective in terms of removing all cancer cells and as good, if not better than traditional open surgery.

4 1 2 The robot-assisted partial nephrectomy Indications Recovery Kidney reconstruction Effectiveness Patient diagnosed with stage 1 kidney cancer, or tumour less than 7cm in diameter. Studies suggest robot assisted surgery can be considered for more complex tumours which may not be suitable for laparoscopic techniques. Following robot-assisted partial nephrectomy, patients spend an average of 1 2 days in hospital, compared with 5 7 after an open procedure. They return to work 3 5 weeks after surgery, compared with 4 6 weeks after an open procedure. Large multi-centre studies have shown that robot-assisted partial nephrectomy offers notable benefits, such as improved ease of reconstruction (stitching), reduced blood loss and shorter hospital stay, compared with laparoscopic surgery. A large, multi-centre study found that robot-assisted partial nephrectomy is a safe and viable alternative to laparoscopic surgery. 1 References 1 Brian M. Benwaya, Sam B. Bhayani, Craig G. Rogers, Lori M. Dulabonc, Manish N. Patel, Michael Lipkin, Agnes J. Wanga, Michael D. Stifelman (2008). Robot-assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: a multi-institutional analysis of perioperative outcomes.

5 We are a group of urologists who are all leading specialists in our fields. Together, we provide comprehensive services of the highest standard for prostate cancer, bladder, kidney and sexual problems. Holding posts in nationally renowned teaching hospitals, we use the most advanced diagnostics to assess and understand problems. This enables us to offer individually tailored, effective treatment, including for the most complex conditions. We offer our patients the assurance of extensive experience of the treatments we offer. Many studies have shown how outcomes for patients are directly linked to the number of cases their surgeon has undertaken. We offer consultations and treatment in a variety of prestigious central locations: 9 Harley Street BMI Fitzroy Square Hospital BMI Weymouth Hospital

6 OUR ROBOT-ASSISTED PROSTATE AND KIDNEY SURGERY SPECIALISTS Mr Marc Laniado Mr Marc Laniado has been a consultant in the Thames Valley and West London Region since 2002, diagnosing and treating patients with prostate enlargement and cancer, and kidney cancer. He specialises in rapid diagnostic techniques and both robotic and laparoscopic surgery for prostate and kidney problems, including nephrectomy and pyeloplasty. He has recently performed single port laparoscopic surgery. Mr Laniado has an interest in minimally invasive treatments and is involved in the training of consultants and trainees in laparoscopic kidney surgery and laparoscopic prostatectomy. Mr Alan Doherty Mr Alan Doherty is one of the most experienced surgeons in prostatectomy within the UK, having undertaken a total of more than 1,200 procedures. He was one of the first surgeons to carry out prostatectomy as a laparoscopic procedure. Mr Doherty has now completed 600 laparoscopic prostatectomies and is highly experienced in nerve-sparing techniques. Mr Doherty is one of a small number of specialist surgeons regularly undertaking laparoscopic cystectomy (bladder removal) and laparoscopic nephrectomy (kidney removal). Mr Doherty s NHS post is Consultant Urologist at the Queen Elizabeth Hospital in Birmingham, the region s largest urological centre. OUR TEAM OF CONSULTANT UROLOGISTS Simon Choong David Ralph Jeremy Ockrim Kidney, ureteric and bladder stones Peyronie s disease, vasectomy reversal Incontinence, bladder and pelvic pain Correspondence address: Harley Street Urology, 14 Fitzroy Square, London W1T 6ES

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