The combination of a surgeon’s skills, an experienced clinical team and a robot called da Vinci is delivering fantastic outcomes for men suffering from prostate cancer.
In the past year, almost 200 patients from all over the west of Scotland have been referred into the Queen Elizabeth University Hospital to have robotic-assisted laparoscopic prostatectomy. And in the year ahead, that number will increase to nearer 300.
This development in surgical techniques and technology delivers better outcomes, reduces side effects, reduces the chances of surgical complications and dramatically shortens the length of the post-operative hospital stay. In many cases, a patient can leave hospital a day after surgery and return to work within a couple of weeks.
We are currently in the position where Imran Ahmad and Mark Underwood are delivering this regional service, with a further surgeon, Jaimin Bhatt, in training. A fourth experienced surgeon, Lorenzo Dutto, from the largest-volume prostatectomy centre in Germany, is joining the team in early 2018.
As a result, we are beginning to see a positive impact on waiting times, which have reduced from 17 to 10-12 weeks. Early outcome data is also extremely positive and in line with, or better than, data from international centres of excellence. This is testament to the skills of the regional team that includes the surgical team, radiology, pathology, specialist nursing and administrative staff.
Referrals come from each of the NHS Boards in the west of Scotland with robust patient pathways agreed by the regional Managed Clinical Network for Urological Cancers to support delivery of as much care as possible close to the patient’s home.
Initial diagnostic work takes place in the patient’s local health board where treatment options are discussed. If surgery is the preferred option, the patient is referred to the regional team, who review and plan their surgical care. The use of robotic techniques has reduced the average length of stay from four to one-two days, with the majority of patients discharged directly to home and their ongoing management transferred to their local healthcare team.
Our photograph below left shows surgeon Imran Ahmad operating a highly sensitive machine giving him 3D vision inside the patient. Using a thumb and the middle finger on each hand, he completes intricate incisions and controls aspects of movement with foot pedals to add further flexibility and control.
Imran’s movements result in the four “arms” of robot da Vinci responding to his instructions. The arms extend tiny incisors through small “portholes” in the patient’s body similar to keyhole surgery.
One arm controls the camera and the others can lift, cut and stitch according to the controls of the surgeon. A full team of anaesthetic specialists, advanced scrub practitioners and theatre assistants are there to ensure everything goes smoothly for the patient and the whole operation to remove a cancerous prostate can be completed in two hours… without the robot, such an operation could have lasted five hours.
Visit Flickr to view a selection of photos and videos taken during the procedure.