Laparoscopic surgery, is when surgeons operate using long, thin instruments inserted through small punctures or slits in the skin.
Robotic-assisted surgery takes laparoscopic surgery a step further.
The surgical instruments are mounted on a robot, which surgeons control from a console.
Patients who undergo robotic surgery experience less pain and recover faster.
Clayton S. Lau, MD is here to discuss robot assisted surgery, it's benefits and possible drawbacks.
Selected Podcast
Using Robotic Surgery to Treat Urologic Cancers
Featured Speaker:
Learn more about Dr. Lau
Clayton S. Lau, MD
Dr. Lau is an Associate Clinical Professor in the Department of Urology and Urologic Oncology at City of Hope. His expertise and interests are in minimally invasive approaches to urologic oncology and reconstructive urology. He has lectured and taught numerous surgeons robotic surgery throughout the nation and is the Director of the Fellowship in Urologic Oncology/Robotic Surgery at City of Hope.Learn more about Dr. Lau
Transcription:
Using Robotic Surgery to Treat Urologic Cancers
Melanie Cole (Host): At City of Hope, our physicians are leading experts in treating patients with all type of urologic cancers. Just as no two patients are alike, cancer requires a unique treatment plan, tailored to each individual to attain the best possible outcomes. My guest today is Dr. Clayton Lau. He’s an associate clinical professor in the Department of Urology and Urologic Oncology at City of Hope. Welcome to the show, Dr. Lau. So tell us a little bit about robotic-assisted surgery. What is that? It sounds very new space age, but really, what is it?
Dr. Clayton Lau (Guest): Good morning, Melanie. Thank you. Robotic surgeries have been around for over a decade now and it’s taking laparoscopic surgery, which is a minimally invasive operation, where one, instead of making a big incision, fills up the abdomen with a gas, makes tiny incisions, puts ports in, and puts small instruments to do the operation that we would do just like an open operation. With robotic surgery, what we’re doing is taking it further by connecting the laparoscopic ports to a robotic interface, where one can use advanced cameras, where we can use magnification 12 times the human eye. We can use wristed instruments and different instruments, just like in doing the open operations. We do much more fine dissection and more complex operations.
Melanie: So the difference between that robotic-assisted surgery and the laparoscopic surgeries are…?
Dr. Lau: The biggest distinction is using the robotic interface. With the laparoscopic surgery, one would have to just use their hands. With the robot, you sit behind what appears to be a robotic console. It’s like a video game console, in a sense, where one surgeon will sit comfortably and use all the advantages of the robot with the visual optics and the instruments themselves. In addition, the instruments, if even one were to shake while we’re doing the insert, it cancels it out, so it will make a surgeon almost a better surgeon.
Melanie: Wow, that’s really neat. And the way that you guys have been trained to use this robotic surgery, how is the training for this? Does it take a lot of practice to use this equipment?
Dr. Lau: It certainly does. The company that makes the robot is called Intuitive Surgical. It is intuitive but it takes quite a bit of training and there certainly is a learning curve where it takes hundreds of cases to get facile at it. In addition, what we found with having done over thousands of procedures, we’re still getting better. I think that we’re actually getting more efficient and better and finding more uses in different procedures and doing the operations.
Melanie: So what type of urologic procedures can be done using these robotic-assisted techniques?
Dr. Lau: The most common procedures that we’ll do is a radical prostatectomy for prostate cancer. Also, it’s very commonly done for nephrectomies or kidney removals, partials and radicals, and also for cystectomies which are bladder removals, and they’re all for specific cancers – prostate cancer, kidney cancer, and also bladder cancer. We can also use it for less common cancers such as adrenal cancers. But the robot can be used in a multidisciplinary fashion where you can use it for lung cancer, for colon cancer. So if a person actually has a colon cancer and a kidney cancer, you can do the operation at the same time and use the robot.
Melanie: Are there some people, Dr. Lau, that are not candidates for using this robotic type equipment?
Dr. Lau: I think there are some candidates where the disease is widely metastatic, where an open operation is needed. But frankly speaking, even at the Cancer Center at City of Hope, I would say in urology, about 95 percent of our cancer operations are done robotically.
Melanie: Dr. Lau, I’m sure this is a question that many patients have: What if the equipment fails during the operation? What happens then?
Dr. Lau: Well, typically, the surgeons that are trained to do robotics are trained to do conventional operations so they’ll just switch over to the conventional operation. But at the City of Hope, we actually have the luxury of having more robots. So when it happens, and it’s really uncommon to happen where a robot has a breakdown where it’s non-recoverable, in other words, it can’t restart back up, sometimes they’re like any electronic device. You can just turn it off and turn it back on. Usually, it works again. But if that happens, and maybe it happens once every two or three years, we’ll just bring another robot in the room. Other than that, we can just do the old standard approach or the open approach or even just laparoscopic and just complete the operation.
Melanie: So does this make it less recovery time? Is there any advantage to using the robot for prostate cancer or kidney or bladder cancer? If you’re using the robot for these types of surgeries, are there any advantages in recovery time?
Dr. Lau: There certainly are. I mean, most patients, what we found is that they’re actually in the hospital in much less time, less chance of a complication or infections. So they can get back to their life sooner – back to work, back to working out, just getting back to their normal routines. So there’s huge advantages. Also, blood loss is much less common with these sort of operations.
Melanie: So then what happens afterwards? You’re using the robotic surgery, then there’s recovery time. Is this something that needs rechecking? Do you go back in ever and look? How does that work?
Dr. Lau: Even after an open operation, most patients with cancer have a specific followup and that might entail blood work or CT scans afterwards. And depending on the type of cancer or the extent of the cancer, we would put them on a protocol to survey them afterwards to make sure that the cancer doesn’t come back. And if it does, we would apply the appropriate adjuvant or salvage therapies if needed.
Melanie: Tell us about the horizon. What’s going on with robotic surgery that’s very exciting at City of Hope, Dr. Lau?
Dr. Lau: We have the latest and greatest of the newest robots. We use special cameras, special lights to help determine margins or edges. Instead of just using fluorescent lights. We’re also developing our own proprietary camera to help determine the edges of where the tumor begins and the normal tissue begins also. In addition, we do quite a bit of training for many physicians worldwide. We have so much experience that many physicians come here to learn. It’s an exciting place, and I would tell you that it seems like every 6 months or 12 months, we always have new devices to make the operations even easier. Before, we can only do a few operations with robotics, but now, sky is the limit. We can do most major operations robotically.
Melanie: Now, Dr. Lau, in just the last few minutes, please give the listeners your best advice on considering different urologic cancers and those that might need surgery, and really give them some comfort in knowing that the robots are going to be really their best option.
Dr. Lau: I think robotics a decade ago was deemed to be experimental. But nowadays, it’s commonplace for most hospitals including larger community hospitals to academic hospitals to VAs. It’s commonly used even for benign conditions, just for hysterectomies or whatnot. So it has actually become a standard instrument for many surgeons out there, and the benefits are incredible for most patients that undergo surgery, especially with the recovery time and less blood loss. It is the standard, and with experience, surgeons are getting better and we’re seeing a lot of the benefits. I think the most important thing for a patient when they’re choosing their surgeon is to make sure that their surgeon has the experience doing this specific technique before proceeding.
Melanie: Thank you so much, Dr. Lau. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.
Using Robotic Surgery to Treat Urologic Cancers
Melanie Cole (Host): At City of Hope, our physicians are leading experts in treating patients with all type of urologic cancers. Just as no two patients are alike, cancer requires a unique treatment plan, tailored to each individual to attain the best possible outcomes. My guest today is Dr. Clayton Lau. He’s an associate clinical professor in the Department of Urology and Urologic Oncology at City of Hope. Welcome to the show, Dr. Lau. So tell us a little bit about robotic-assisted surgery. What is that? It sounds very new space age, but really, what is it?
Dr. Clayton Lau (Guest): Good morning, Melanie. Thank you. Robotic surgeries have been around for over a decade now and it’s taking laparoscopic surgery, which is a minimally invasive operation, where one, instead of making a big incision, fills up the abdomen with a gas, makes tiny incisions, puts ports in, and puts small instruments to do the operation that we would do just like an open operation. With robotic surgery, what we’re doing is taking it further by connecting the laparoscopic ports to a robotic interface, where one can use advanced cameras, where we can use magnification 12 times the human eye. We can use wristed instruments and different instruments, just like in doing the open operations. We do much more fine dissection and more complex operations.
Melanie: So the difference between that robotic-assisted surgery and the laparoscopic surgeries are…?
Dr. Lau: The biggest distinction is using the robotic interface. With the laparoscopic surgery, one would have to just use their hands. With the robot, you sit behind what appears to be a robotic console. It’s like a video game console, in a sense, where one surgeon will sit comfortably and use all the advantages of the robot with the visual optics and the instruments themselves. In addition, the instruments, if even one were to shake while we’re doing the insert, it cancels it out, so it will make a surgeon almost a better surgeon.
Melanie: Wow, that’s really neat. And the way that you guys have been trained to use this robotic surgery, how is the training for this? Does it take a lot of practice to use this equipment?
Dr. Lau: It certainly does. The company that makes the robot is called Intuitive Surgical. It is intuitive but it takes quite a bit of training and there certainly is a learning curve where it takes hundreds of cases to get facile at it. In addition, what we found with having done over thousands of procedures, we’re still getting better. I think that we’re actually getting more efficient and better and finding more uses in different procedures and doing the operations.
Melanie: So what type of urologic procedures can be done using these robotic-assisted techniques?
Dr. Lau: The most common procedures that we’ll do is a radical prostatectomy for prostate cancer. Also, it’s very commonly done for nephrectomies or kidney removals, partials and radicals, and also for cystectomies which are bladder removals, and they’re all for specific cancers – prostate cancer, kidney cancer, and also bladder cancer. We can also use it for less common cancers such as adrenal cancers. But the robot can be used in a multidisciplinary fashion where you can use it for lung cancer, for colon cancer. So if a person actually has a colon cancer and a kidney cancer, you can do the operation at the same time and use the robot.
Melanie: Are there some people, Dr. Lau, that are not candidates for using this robotic type equipment?
Dr. Lau: I think there are some candidates where the disease is widely metastatic, where an open operation is needed. But frankly speaking, even at the Cancer Center at City of Hope, I would say in urology, about 95 percent of our cancer operations are done robotically.
Melanie: Dr. Lau, I’m sure this is a question that many patients have: What if the equipment fails during the operation? What happens then?
Dr. Lau: Well, typically, the surgeons that are trained to do robotics are trained to do conventional operations so they’ll just switch over to the conventional operation. But at the City of Hope, we actually have the luxury of having more robots. So when it happens, and it’s really uncommon to happen where a robot has a breakdown where it’s non-recoverable, in other words, it can’t restart back up, sometimes they’re like any electronic device. You can just turn it off and turn it back on. Usually, it works again. But if that happens, and maybe it happens once every two or three years, we’ll just bring another robot in the room. Other than that, we can just do the old standard approach or the open approach or even just laparoscopic and just complete the operation.
Melanie: So does this make it less recovery time? Is there any advantage to using the robot for prostate cancer or kidney or bladder cancer? If you’re using the robot for these types of surgeries, are there any advantages in recovery time?
Dr. Lau: There certainly are. I mean, most patients, what we found is that they’re actually in the hospital in much less time, less chance of a complication or infections. So they can get back to their life sooner – back to work, back to working out, just getting back to their normal routines. So there’s huge advantages. Also, blood loss is much less common with these sort of operations.
Melanie: So then what happens afterwards? You’re using the robotic surgery, then there’s recovery time. Is this something that needs rechecking? Do you go back in ever and look? How does that work?
Dr. Lau: Even after an open operation, most patients with cancer have a specific followup and that might entail blood work or CT scans afterwards. And depending on the type of cancer or the extent of the cancer, we would put them on a protocol to survey them afterwards to make sure that the cancer doesn’t come back. And if it does, we would apply the appropriate adjuvant or salvage therapies if needed.
Melanie: Tell us about the horizon. What’s going on with robotic surgery that’s very exciting at City of Hope, Dr. Lau?
Dr. Lau: We have the latest and greatest of the newest robots. We use special cameras, special lights to help determine margins or edges. Instead of just using fluorescent lights. We’re also developing our own proprietary camera to help determine the edges of where the tumor begins and the normal tissue begins also. In addition, we do quite a bit of training for many physicians worldwide. We have so much experience that many physicians come here to learn. It’s an exciting place, and I would tell you that it seems like every 6 months or 12 months, we always have new devices to make the operations even easier. Before, we can only do a few operations with robotics, but now, sky is the limit. We can do most major operations robotically.
Melanie: Now, Dr. Lau, in just the last few minutes, please give the listeners your best advice on considering different urologic cancers and those that might need surgery, and really give them some comfort in knowing that the robots are going to be really their best option.
Dr. Lau: I think robotics a decade ago was deemed to be experimental. But nowadays, it’s commonplace for most hospitals including larger community hospitals to academic hospitals to VAs. It’s commonly used even for benign conditions, just for hysterectomies or whatnot. So it has actually become a standard instrument for many surgeons out there, and the benefits are incredible for most patients that undergo surgery, especially with the recovery time and less blood loss. It is the standard, and with experience, surgeons are getting better and we’re seeing a lot of the benefits. I think the most important thing for a patient when they’re choosing their surgeon is to make sure that their surgeon has the experience doing this specific technique before proceeding.
Melanie: Thank you so much, Dr. Lau. You’re listening to City of Hope Radio. For more information, you can go to cityofhope.org. That’s cityofhope.org. This is Melanie Cole. Thanks so much for listening.