Live robotic surgery gives insight into future of prostatectomies
Posted on 5 December 2016
A first in South Africa, Mediclinic Durbanville played host to a conference featuring a live robotic assisted very complex laparoscopic prostatectomy with extended nodal dissection. The procedure was performed by internationally recognised authority on robotic surgery, Dr Magnus Annerstedt, from the Department of Urology at the Herlev University Hospital, Denmark and was broadcast live to a large number of urologists from across the country specialising in such surgery.
The patient selected for this procedure provided quite a difficult case because of the advanced nature of the prostate cancer. ‘With the new techniques we have learnt on the Da Vinci robot, advanced cases of prostate and bladder cancer are now operable including extended nodal dissection, allowing us to offer our patients the greatest chance of being free of cancer,’ says Dr Annerstedt.
While robot assisted surgery is nothing new in South Africa, the skills displayed by Dr Magnus Annerstedt provided the 30 urologists present with a tremendous amount of insight into the results that can be accomplished through such surgery.
Dr Gawie Bruwer, da Vinci surgeon based at Mediclinic Durbanville and moderator for the event, emphasises, ‘This was not surgery any of the doctors present would have considered lightly due to the complexity of the case, because of the position of the lymph nodes and the presence of large blood vessels. The master class today on operating on advanced prostate cancer gives us new hope for providing this surgery to our patients.’ The outcome of the procedure was exceptionally positive with the patient not requiring a blood transfusion and being discharged two days after the surgery.
While the patient had cancer present outside his prostate and a further treatment plan will be developed to treat this, the prostatectomy also included an extended nodal dissection which was indicated through the Briganti Nomogram, a formula that predicts the probability of lymph node invasion in patients.
Through the surgery and the discussions following the surgery, a standard approach to the dissection of lymph nodes was agreed. This approach will be presented to various branches of the healthcare industry in the coming year. Dr Bruwer notes, ‘It is important for doctors using this technology to follow the criteria accepted worldwide in terms of indications for extended nodal dissection. Where the criteria indicate that lymph node invasion is likely, this procedure may need to be added to the surgery to ensure best outcomes for our patients.’
Dr Bruwer concludes, ‘The surgery performed by Dr Annerstedt clearly showed the potential of the machine as well as where the future of this field of surgery lies. We are excited to develop our skills further, creating better results for the patients we are operating on.’