Trevor MacKay was busy training for a triathlon last November. Cancer was the furthest thing from his mind, but following a routine physical he got the shocking prognosis of prostate cancer. So the 49-year-old did his homework, interviewed several surgeons and made an important decision.
"I chose to have robotic-assisted surgery over radiation or traditional surgery," MacKay said. "My case was fairly advanced and I was confident that the robotic procedure would get rid of the cancer."
He was especially sold on the fast recovery time and fewer side effects than traditional surgery, which can affect urinary and sexual function. So UC Irvine Health surgeon Dr. Thomas Ahlering performed the prostectomy with robotics, and only three days later all MacKay’s systems were go.
"After the procedure, I experienced no pain," he said. "A lot of my father’s friends who had traditional surgery were laid up for six to eight weeks. I walked three miles just three days after surgery.”
The cutting edge
MacKay and thousands like him are benefiting from a revolution launched just 11 years ago with the pioneering da Vinci Surgical System, first developed exclusively for prostate surgery but now a high-tech tool for a wide range of cancers, including head and neck, lung, esophageal, kidney, gynecologic and colorectal.
It’s a perfect collaboration of surgical skill and advanced technology. And contrary to what some might think, no actual robots are used. Real surgeons guide the procedure while viewing a high-resolution 3-D image of the surgical site through a small camera. Miniaturized instruments — inserted into the body through only a few small incisions — are controlled by robotic arms operated by the surgeon’s hand movements.
The result is reduced blood loss, fewer complications and much less post-op pain, said Dr. John (Jeb) Brown, medical director of minimally invasive gynecologic surgery at Hoag Memorial Hospital Presbyterian, one of the few medical centers in the state to have four new-generation da Vinci Si systems.
“Patients often are able to return home the same day or following a very brief stay,” Brown said. "Recovery time is shortened dramatically, and many of our patients now resume normal activities within days, not weeks.”
State of the art
Robotic systems have come a long way. And the evolution continues with the da Vinci Si HD, which allows two surgeons to work together on separate consoles, able to switch control from one to the other at any time.
A hotbed of innovation, the City of Hope helped pioneer an imaging process that causes healthy tissue to glow, enabling the surgeon to target malignant masses and minimize damage to healthy tissue. A dye is infused into the patient’s blood, and an attachment allows the surgeon to shine a light on the area of the tumor.
Even greater innovations are right around the corner, Brown said.
“Advanced as these techniques may be, to quote the old show-biz phrase, ‘You ain’t seen nothin’ yet,’” Brown said. “As just one example, we will soon be able to routinely make just one small incision, instead of three or four typically required today, for some surgeries. Aided by robotic technology, we’ll be able to thread tiny instruments through this single incision; once in, they will branch out, so to speak, and make their way to the surgical site.
“This innovative technology was recently employed by Dr. Steve Beanes at Hoag to remove a diseased gallbladder. This advancement will further decrease post-operative pain while hastening recovery times.”