Prostatectomy using the DaVinci Robotic System

Robotically-Assisted Radical Prostatectomy

Vanderbilt's first robotic surgery was performed in mid-May of 2003 by Smith, who used VUMC's $1 million-plus Da Vinci Surgical System, built by Intuitive Surgical, to perform a radical prostatectomy.

"The Da Vinci robot uses three arms, one for the endoscope and two for surgical instruments, each entering the patient through its own port. "It's very intuitive," said Smith, who hadn't worked much with endoscopic technique before training on the robotic system. Hand movements mimic those of open surgery, allowing Smith to transfer to the robotic approach the skills and experience he has gained in performing more than 2,000 open radical prostatectomies.

Sitting across the room from the patient and using his feet to manipulate the endoscope, Smith looks through a hooded display at a three-dimensional view of the operating field, magnified 15 times. "You see nerves and other features much better than in open surgery," he said.

Wrapped in Velcro strips, Smith's middle fingers and thumbs are wired so that their movements are relayed to the surgical instruments, minus the normal tremor that hands produce. Using different control settings, Smith can scale the robot motion up or down, so that a hand movement of 5 cm, for example, could move the instruments one-half or 3 or 8 cm (for prostatectomy he chooses to work close to actual scale). Dissection of nerves is more precise and suturing is easier, and Smith can rotate instruments as he never could hope to using only his wrists. As the case progresses the instruments such as scalpels, cautery, and needle holders. are periodically exchanged by another physician stationed at the patient's side.