In recent years, robotic surgery has become an alternative to standard open surgery as well as standard minimally invasive procedures for many urologic conditions. Robotic surgery may reduce pain and recovery time for many patients.
In this segment, Timothy J. Ruddell, MD., discusses robotic surgery for urologic disorders and how at Texoma Medical Center they perform procedures using The da Vinci® Si HD® Surgical System, a highly advanced technological surgical system that may provide even further benefits to those already experienced by patients who undergo minimally invasive surgery.
Selected Podcast
Robotic Surgery for Urologic Disorders
Featured Speaker:
Timothy J. Ruddell, MD
Dr. Tim Ruddell, is a Urologist and a member of the medical staff at Texoma Medical Center. He is trained to perform urologic procedures using the daVinci Surgical System at the Center for Robotic Surgery. Transcription:
Robotic Surgery for Urologic Disorders
Melanie Cole (Host): Using minimally invasive robotic surgery to treat urological disorders has rapidly grown as an option for many patients and it may reduce pain and recovery time. My guest today, is Dr. Timothy Ruddell. He is a urologist and a member of the medical staff at Texoma Medical Center. Welcome to the show Dr. Ruddell. So, what urological procedures and be performed using robotic technology?
Dr. Timothy J. Ruddell, MD (Guest): There are a number of different procedures that can be performed using the da Vinci robot. Most of our intrabdominal surgeries that we do, that we perform as urologists can be performed robotically; most commonly, these would be robotic prostatectomies for men who have prostate cancer and desire definitive surgical therapy of their prostate cancer. Other things that could be done are various kidney surgeries including kidney removal for cancer or nonfunctioning kidney for whatever the cause may be. We also perform partial removal of kidneys for example, if the patient has a tumor in their kidney that is small enough that we can resect only the tumor itself rather than the whole kidney, we can actually remove just the tumor robotically. We also can perform various reconstructive surgeries on the kidney and ureter whether that be through scarring from passage of kidney stones or reconstructive surgeries on congenital abnormalities of the way the kidney and ureter join together.
Melanie: So, how is this different than performing these procedures using traditional surgical methods?
Dr. Ruddell: So, the difference is the minimally invasive nature of this. Traditionally, all of these surgeries that I previously mentioned, were performed through large open intraabdominal incisions, so a large incision down the midline of the abdomen or under the ribcage. So, these are done through small incisions. How it compares to plain laparoscopic surgery is it gives you a third dimension of imaging whereas traditional laparoscopic surgery only has two dimensions. It is like watching a television in two dimensions. There is no depth perception. So, robotic surgery gives you a third dimension and gives a surgeon the ability to perform laparoscopic surgery in three dimensions and gives them better depth perception in doing so. Also, the robotic technology, the motion of the instruments is extremely precise. It gives what we call a wristed technology where it actually mimics the degrees of motion that your wrists have and there is really no other laparoscopic technology that has this.
Melanie: So, what are some of the benefits to the patient besides what you have just described as the difference with the traditional surgical methods? What are some of the other benefits to the patient?
Dr. Ruddell: The benefits to the patient most definitely probably that they will appreciate the most is the shorter hospital stay. The hospital stay for example, for an open prostatectomy done through a low abdominal incision traditionally was 5-7 days. Most patients are out of the hospital within 24-hours of their robotic prostatectomy. This corresponds to much less blood loss during the surgery because the blood vessels around the surgical field can be visualized and controlled earlier which therefore correlates with shorter hospital stays. Patients have less pain from the smaller incisions and this all boils down to a quicker recovery for the patient to get them back to doing their normal daily activities much more rapid than through traditional surgical techniques.
Melanie: And what about benefits to the surgeon, Dr. Ruddell, you mentioned is it more precise and sensitive and maybe it can spare delicate nerves. Tell us about, as a surgeon, why you find this so appealing.
Dr. Ruddell: Absolutely, so, for example, during the robotic prostatectomy, which I do a very large number of; there are delicate nerves that control erectile and sexual function postoperatively. There are also muscle fibers in the area that control urinary continence. So, traditional side effects of prostatectomy are erectile dysfunction and urinary incontinence. Using the robotic technology, these nerve bundles and muscles are much more easily spared, therefore correlating to better rate in nerve sparing prostatectomy, better erectile function, and better sexual function following prostatectomy and in my opinion, better continence rate and less urinary incontinence after the procedure. These nerves can be visualized, they can be easily separated off of the capsule of the prostate, whereas doing open prostatectomies, there is usually a large amount of blood in the field, these nerves are barely visualized and are much more difficult to take the care to spare them completely compared to the robotic technique.
Melanie: Dr. Ruddell, are there some patients for whom they are not a candidate for this type of surgery and they must undergo the open traditional type?
Dr. Ruddell: Yes, there are a few reasons why patients would not be an ideal candidate for this. Typically, body mass index of greater than 40, it is difficult to ventilate patients in the position that we have them in for robotic prostatectomy. The position that the patient is required to be in, we actually put them in what is called Trendelenburg which is where the feet are actually elevated in the air and the head is down, so they are sloping downward toward the head. Carrying excess abdominal weight puts weight on the lungs and it is difficult for the anesthesiologist to adequately ventilate patients. Other than that, specific to the robot, that is really the only reason they would not be a candidate for it. Of course, there are other reasons why patients are not ideal surgical candidates in general. If they have severe cardiac disease, have had numerous heart surgeries, do not have good heart or lung function that they are just not healthy enough for an anesthetic, but that would be to any surgery, not specific to the robotic surgery.
Melanie: And Dr. this is just a question that some patients might want to know. Is it difficult to learn how to use the da Vinci Surgical System? I mean obviously, we have great respect for surgeons and everything that you guys do, but is this a difficult process? Does it take a lot of additional training to learn how to use these new techniques?
Dr. Ruddell: Yes, it takes a great deal of training to learn how to use these. The learning curve has been well-studied through the urologic procedures that are done in addition to the various other surgical specialties that use the da Vinci robot and across the board, the learning curves are very high, so the bottom line is you want to have a da Vinci robotic surgical procedure performed by someone who has had specialized training in that. It is very difficult to learn that without having specialized training and it is difficult to get the volume necessary to overcome that learning curve of performing these surgeries.
Melanie: So, in summary, what would you like people to know about urologic issues and disorders and the treatment options available through robotic surgery?
Dr. Ruddell: The robotic surgery has really revolutionized the way we practice urology. It is a great benefit to the patient. The da Vinci robot was really designed for the robotic prostatectomy, but now we have found many different reasons to use it and ways we have improved our surgical outcomes. Patients do so much better having the da Vinci robotic surgeries performed. A patient, when they are being evaluated for surgical therapy, they should always do their due diligence and research that the options that are delivered to them are the – are all the options available, because there are many surgeons, urologists, etc. that may not offer if because they were never trained on it. But that doesn’t mean that you can’t find someone that is trained on it and those options are widely available in the United States now. Here at Texoma Medical Center, we do a very large number of robotic surgeries. There are several different surgeons that use it. I am the only urologist in the area that currently uses the robotic technology, so if you are facing prostate surgery, kidney surgery, you should always look at your options and evaluate them and I am happy to see you to come talk about the robotic surgery if necessary.
Melanie: Thank you so much, Dr. Ruddell for being with us today. You are listening to TMC Health Talk with Texoma Medical Center. For more information, please go to texomamedicalcenter.net. That’s texomamedicalcenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if robotic surgery is right for you. This is Melanie Cole. Thanks so much for listening.
Robotic Surgery for Urologic Disorders
Melanie Cole (Host): Using minimally invasive robotic surgery to treat urological disorders has rapidly grown as an option for many patients and it may reduce pain and recovery time. My guest today, is Dr. Timothy Ruddell. He is a urologist and a member of the medical staff at Texoma Medical Center. Welcome to the show Dr. Ruddell. So, what urological procedures and be performed using robotic technology?
Dr. Timothy J. Ruddell, MD (Guest): There are a number of different procedures that can be performed using the da Vinci robot. Most of our intrabdominal surgeries that we do, that we perform as urologists can be performed robotically; most commonly, these would be robotic prostatectomies for men who have prostate cancer and desire definitive surgical therapy of their prostate cancer. Other things that could be done are various kidney surgeries including kidney removal for cancer or nonfunctioning kidney for whatever the cause may be. We also perform partial removal of kidneys for example, if the patient has a tumor in their kidney that is small enough that we can resect only the tumor itself rather than the whole kidney, we can actually remove just the tumor robotically. We also can perform various reconstructive surgeries on the kidney and ureter whether that be through scarring from passage of kidney stones or reconstructive surgeries on congenital abnormalities of the way the kidney and ureter join together.
Melanie: So, how is this different than performing these procedures using traditional surgical methods?
Dr. Ruddell: So, the difference is the minimally invasive nature of this. Traditionally, all of these surgeries that I previously mentioned, were performed through large open intraabdominal incisions, so a large incision down the midline of the abdomen or under the ribcage. So, these are done through small incisions. How it compares to plain laparoscopic surgery is it gives you a third dimension of imaging whereas traditional laparoscopic surgery only has two dimensions. It is like watching a television in two dimensions. There is no depth perception. So, robotic surgery gives you a third dimension and gives a surgeon the ability to perform laparoscopic surgery in three dimensions and gives them better depth perception in doing so. Also, the robotic technology, the motion of the instruments is extremely precise. It gives what we call a wristed technology where it actually mimics the degrees of motion that your wrists have and there is really no other laparoscopic technology that has this.
Melanie: So, what are some of the benefits to the patient besides what you have just described as the difference with the traditional surgical methods? What are some of the other benefits to the patient?
Dr. Ruddell: The benefits to the patient most definitely probably that they will appreciate the most is the shorter hospital stay. The hospital stay for example, for an open prostatectomy done through a low abdominal incision traditionally was 5-7 days. Most patients are out of the hospital within 24-hours of their robotic prostatectomy. This corresponds to much less blood loss during the surgery because the blood vessels around the surgical field can be visualized and controlled earlier which therefore correlates with shorter hospital stays. Patients have less pain from the smaller incisions and this all boils down to a quicker recovery for the patient to get them back to doing their normal daily activities much more rapid than through traditional surgical techniques.
Melanie: And what about benefits to the surgeon, Dr. Ruddell, you mentioned is it more precise and sensitive and maybe it can spare delicate nerves. Tell us about, as a surgeon, why you find this so appealing.
Dr. Ruddell: Absolutely, so, for example, during the robotic prostatectomy, which I do a very large number of; there are delicate nerves that control erectile and sexual function postoperatively. There are also muscle fibers in the area that control urinary continence. So, traditional side effects of prostatectomy are erectile dysfunction and urinary incontinence. Using the robotic technology, these nerve bundles and muscles are much more easily spared, therefore correlating to better rate in nerve sparing prostatectomy, better erectile function, and better sexual function following prostatectomy and in my opinion, better continence rate and less urinary incontinence after the procedure. These nerves can be visualized, they can be easily separated off of the capsule of the prostate, whereas doing open prostatectomies, there is usually a large amount of blood in the field, these nerves are barely visualized and are much more difficult to take the care to spare them completely compared to the robotic technique.
Melanie: Dr. Ruddell, are there some patients for whom they are not a candidate for this type of surgery and they must undergo the open traditional type?
Dr. Ruddell: Yes, there are a few reasons why patients would not be an ideal candidate for this. Typically, body mass index of greater than 40, it is difficult to ventilate patients in the position that we have them in for robotic prostatectomy. The position that the patient is required to be in, we actually put them in what is called Trendelenburg which is where the feet are actually elevated in the air and the head is down, so they are sloping downward toward the head. Carrying excess abdominal weight puts weight on the lungs and it is difficult for the anesthesiologist to adequately ventilate patients. Other than that, specific to the robot, that is really the only reason they would not be a candidate for it. Of course, there are other reasons why patients are not ideal surgical candidates in general. If they have severe cardiac disease, have had numerous heart surgeries, do not have good heart or lung function that they are just not healthy enough for an anesthetic, but that would be to any surgery, not specific to the robotic surgery.
Melanie: And Dr. this is just a question that some patients might want to know. Is it difficult to learn how to use the da Vinci Surgical System? I mean obviously, we have great respect for surgeons and everything that you guys do, but is this a difficult process? Does it take a lot of additional training to learn how to use these new techniques?
Dr. Ruddell: Yes, it takes a great deal of training to learn how to use these. The learning curve has been well-studied through the urologic procedures that are done in addition to the various other surgical specialties that use the da Vinci robot and across the board, the learning curves are very high, so the bottom line is you want to have a da Vinci robotic surgical procedure performed by someone who has had specialized training in that. It is very difficult to learn that without having specialized training and it is difficult to get the volume necessary to overcome that learning curve of performing these surgeries.
Melanie: So, in summary, what would you like people to know about urologic issues and disorders and the treatment options available through robotic surgery?
Dr. Ruddell: The robotic surgery has really revolutionized the way we practice urology. It is a great benefit to the patient. The da Vinci robot was really designed for the robotic prostatectomy, but now we have found many different reasons to use it and ways we have improved our surgical outcomes. Patients do so much better having the da Vinci robotic surgeries performed. A patient, when they are being evaluated for surgical therapy, they should always do their due diligence and research that the options that are delivered to them are the – are all the options available, because there are many surgeons, urologists, etc. that may not offer if because they were never trained on it. But that doesn’t mean that you can’t find someone that is trained on it and those options are widely available in the United States now. Here at Texoma Medical Center, we do a very large number of robotic surgeries. There are several different surgeons that use it. I am the only urologist in the area that currently uses the robotic technology, so if you are facing prostate surgery, kidney surgery, you should always look at your options and evaluate them and I am happy to see you to come talk about the robotic surgery if necessary.
Melanie: Thank you so much, Dr. Ruddell for being with us today. You are listening to TMC Health Talk with Texoma Medical Center. For more information, please go to texomamedicalcenter.net. That’s texomamedicalcenter.net. Physicians are independent practitioners who are not employees or agents of Texoma Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. Individual results may vary. There are risks associated with any surgical procedure. Speak with your physician about these risks to find out if robotic surgery is right for you. This is Melanie Cole. Thanks so much for listening.