Joey Wahler (Host): It's improving how a number of conditions are treated. So, we're discussing Urology and Robotics. Our guest is Dr. Benjamin Larson. He's a urologist with Southwest Healthcare. This is Southwest Health Talk with Southwest Healthcare, building relationships that touch the heart. Thanks for joining us.

I'm Joey Wahler. Hi there, Dr. Larson. Welcome.

Benjamin Larson, MD: Thank you. Thanks for having me.

Host: Great to have you board. Appreciate the time. So first, what do we mean in a nutshell by robotics in Urology, and how would you say is the main manner in which it differs from those traditional Urology Surgery techniques of years gone by?

Benjamin Larson, MD: There are a couple of robotic platforms that we are using in Urology, but the primary one is the da Vinci system by intuitive, which allows us to do major surgeries through small incisions, using small instruments with precise control, allowing us to have better visualization and being able to cure a number of diseases from cancer to anomalies that people are born with, with quicker recovery, less downtime, less injury or risks, and improve outcomes overall.

Host: We had touched on it there. What are some of the other common urological conditions that are treated using robotics these days?

Benjamin Larson, MD: Robotic surgery is used in treatment of multiple types of cancer; kidney cancer; bladder cancer, in severe cases; prostate cancer, as well as other deformities that people are born with; scarring that prevents drainage from the kidneys to the bladder, and that could be from things they're born with or other injuries from other surgeries or other conditions; and then, as well as some other issues that can happen, especially in women where there are prolapse of organs and other issues that arise.

Host: So, this is helping to treat women as well.

Benjamin Larson, MD: Correct. And a lot of Urology, even though we do deal with the prostate, which is only men have prostates, everyone has kidneys, everyone has a bladder, and everyone has the need for that urine to get out of the body. 

Host: Absolutely. Perhaps that sometimes gets lost in the context of this type of discussion because urologists are often so much more associated with treating men, aren't they?

Benjamin Larson, MD: Correct. But we do see almost 50 50 men and women patients, and the needs arise from both.

Host: Interesting. You mentioned the da Vinci system. That's kind of the gold standard, if you will, for this type of procedure from an equipment standpoint, right? 

Benjamin Larson, MD: Correct. It's the first in the market for robotic-assisted, not meaning that the robot does the surgery. It just allows us as surgeons to manipulate and finely tune those instruments and control them in more degrees of freedom, whether it's angles and finite movements than we would traditionally with other instruments previously before that.

Host: And speaking of which, it's important to note, isn't it, that the term robotic surgery sometimes throws people that are unfamiliar because it's not as though robots have taken over the OR, right? We still have human doctors like yourself. And so, give people an idea maybe of the training that's involved in using this type of equipment.

Benjamin Larson, MD: Yeah. At this point, in Urology training, I finished my training about 10 years ago. It was still, and it was heavily integrated into that. I would say the majority of doctors' training are now hands-on with it from day one. That involves computer simulations, workshops, using it in other animal labs or other things. And then, slowly learning and seeing and doing in actual human patients.

There are still surgeons who have never used robotic surgery who are taking courses and being proctored or mentored by other surgeons to introduce that into their skills. But as far as Urology goes, we are one of the first fields that use this platform. And so, it's been integrated since day one, I would say, from here on out. 

Host: Gotcha. And so, how would you say robotic Urology improves patient outcomes compared to conventional surgical procedures?

Benjamin Larson, MD: Well, I have a unique advantage of that being a second generation urologist, and my dad was a urologist also before the robotic system came into play. Prior to what we are doing now with the da Vinci system, patients had to be admitted before surgery. They were worked up and prepared. They had large incisions done, sometimes injury nerves and muscles to allow access to those organs. And then, they usually would stay in the hospital even up to a week or so after surgery to control pain and make sure things were healing. Now, those same surgeries, patients are coming in that morning of the surgery. Their surgery is performed in about a relatively same amount of time in the operating room, but some are going home the next day, some even the same day. And much improved outcomes, as well as just the ease of getting back to normal. You're not having to wait months and months for wounds to heal and muscles to regain their strength. You're getting back to normal in a couple weeks or even within a month.

Host: And how important is that to patients, those last few things you mentioned, like being able to get in and out faster and reducing recovery time, et cetera?

Benjamin Larson, MD: Yeah, I think, you know, people don't want to have to lose too much. They're already losing or having a significant risk factor to their health and their lifespan. They're not wanting to have this be a major event in their life. You know, they want to deal with it and want to be able to move past it, which is the goal as a doctor also to help them get through that.

So, being able to be in and out of a hospital where there's other sick people or other infectious diseases is very important. Being able to just return to daily life as quick as possible. We've seen better improvements in outcomes, and avoiding those secondary things that happen from having to be in bed for a couple months while other issues can arise from that. So, this kind of gets people past all those other risks and then back to their normal life as fast as possible.

Host: I'm sure that's very comforting for people to hear. How about the preciseness improvement when using this technology. We hear so much about that being a big advantage for doctors, for surgeons, not just in Urology, but really in all areas of Medicine where this is used. How much of an advantage is that for you and yours and why?

Benjamin Larson, MD: Yeah. It's great because prior to using these modalities with cameras and instruments brought in and right up to the target of the surgery, we would have to make big incisions. We would have to position ourselves in uncomfortable positions to reach and be able to visualize parts in the body. And then, we still were, you know, working with rudimentary instruments to the best of our ability. But there's limits to how big our hands can fit into small spaces. And so, having more smaller instruments that allow us to manipulate them more precisely. So for an example, with this da Vinci surgical platform, we pass the instruments in, position them right next to the organ of interest. And while I sit at the control console and move my hands and wrist, it will scale down to make even finer movements at the tips of the instruments. And that mimics my movement. So, I'm controlling everything. But my movements are even more precise because of the robotic assistance there.

Host: That sounds very cool. How cool is it to use?

Benjamin Larson, MD: It's pretty fun. I've even had my young kids try out demonstration once and they take to it right away, because they're just used to that kind of hand-eye coordination on a screen. But it really allows you to feel like you're right at the problem, getting a good look at everything around, and really know exactly what you're doing with the best precision you can.

Host: Do you ever kind of take a step back and think, "Boy, it's amazing that this kind of technology exists"?

Benjamin Larson, MD: It is. You're sitting there saying, "I'm fixing something so small, but I'm seeing it on a full screen or an immersive eyepiece where it's in three dimensions to my view." And that's much easier than shrinking me down and putting me inside of someone's body. So, it is very cool in that sense. 

Host: That's great. Naturally, most any medical procedure comes with some degree of risks. How about the potential risks of using robotic technology in Urology?

Benjamin Larson, MD: You know, most of the risks that exists are present with any surgery, whether it's this modality open or other approaches, so those are fairly standardized risks for bleeding and infections and, you know, injury to other organs. With robotic surgery, luckily, the software, the hardware, rarely do we have any issues with that that does cause harm. But there always introduces some risk when you're reliant on technology or other instruments that have room for that. But so far, things have been fairly routine, very reliable. And that's what it takes to bring these things to market and then have them introduced, and used in mainstream medical care.

Host: A few other things. How about advancements that have been made recently in robotic systems for Urology? And any idea what's on the horizon in the near future, and how all of that may continue to help to improve that precision and recovery time, et cetera, that you've discussed? 

Benjamin Larson, MD: Sure. So, the intuitive Da Vinci platform has continued to release updated instruments, updated entire platforms that just provide either more compatibility and interoperability. They make it easier in the OR for the staff there to get it all positioned and stuff. So, some of that has just been more improvements on efficiency.

Other things that we've recently introduced at Southwest is another separate robotic system called the Aquablation, which we use for prostate enlargement in men who have difficulty urinating. And that uses ultrasound and high-pressured water to open up a nice big channel through the prostate so men can urinate better. It's an evolution of existing modalities that we've used before, but it's just kind of the newest guided, planned with the robotic assistant, and kind of controlled that way that we've had great success with.

As far as future things, there is new device by da Vinci where it still uses the robotic instruments, but they're all introduced through a single incision, instead of having four or five smaller incisions. That one is currently being used in some locations for Urology, and we'll see how that keeps developing and being applied more to urologic field.

Host: How about the way in which a general practitioner should advise patients considering robotic surgery in Urology? What do you want GPs to know about this?

Benjamin Larson, MD: I think it's being able to tell them that your surgeon is the one using this tool and controlling it. So, there's no need, you know, fear for us pushing a button and going off and getting some coffee. That's not the fear. And otherwise, just to tell them, "Hey, this is the standard of care. This is the way these things should be done." And you want to seek out a urologic surgeon who is doing those and is implementing the latest technology on their behalf. 

Host: And then, finally, we've saved the best for last here in that Rancho Springs Hospital has been designated a Center of Excellence in Robotic Surgery. So, what does that mean to you and your colleagues? That's exciting, right?

Benjamin Larson, MD: Yeah, it was great. It was a long process of documenting the robotic surgeries that we've done, the surgeons who do it, and making sure everyone meets, you know, strict criteria. As that program director, I was involved in getting all those forms and just presenting our data, our safety records, to demonstrate to those certifying bodies that we meet those criteria. And it's something we always knew we were. But it's nice to be recognized and to have that reinforcement, and let patients know, "Hey, this is how well we do things here. And you know, you should be aware."

Host: Well, congratulations on that honor.

Benjamin Larson, MD: Thank you.

Host: And folks, we trust you are now more familiar with Urology and Robotics. Dr. Benjamin Larson, keep up this great cutting edge work. And thanks so much again.

Benjamin Larson, MD: You're welcome. Thank you for having me. 

Host: For more information, please visit swranchosprings.com/services/surgery/roboticsurgery and southwesthealthcaresystem.com. .

Keep in mind, physicians or independent practitioners who are not employees or agents of Southwest Healthcare. The hospital shall not be liable for actions or treatments provided by physicians. If you found this podcast helpful, please do share it on your social media. Thanks again for being part of Southwest Health Talk with Southwest Healthcare, building relationships that touch the heart.