Two Robots Better Than One for Prostate Surgery

Sunday, April 26 2009 00:05

Adding A Second Robot May Help Surgeon to Spare Nerves Controlling Erections

Johns Hopkins researchers have developed a new technique that may improve robotic prostate surgery by using a second robot for taking three-dimensional ultrasound images of the prostate and surrounding structures during the procedure. These images can potentially help surgeons spot the nerve bundle that controls erectile function.

A man's erections depend on the neurovascular bundle (NVB), a collection of blood vessels and nerves, the researchers say. Overlying connective tissue or blood can obscure the NVB during radical prostatectomy, increasing the chance that surgeons will inadvertently damage it.

Researchers at other institutions have sought to image the prostate during nonrobotic laparoscopic prostatectomy, with a radiologist performing a transrectal ultrasound to better identify the NVB while a surgeon operates. However, this separation of duties can make it cumbersome for surgeons to get the precise images they need. Additionally, this technique can’t be done during robotic surgeries, which don’t afford enough space for radiologists to maneuver.

To solve these problems, Hopkins engineers led by Dan Stoianovici, Ph.D., from the Urology Robotics Laboratory developed a compact robot that holds and moves the ultrasound probe remotely, allowing a surgeon to precisely control its position with a joystick. A pilot study of three patients who underwent robotic radical prostatectomy showed that the second robot provides surgeons real-time images that incorporate the position of the surgical robot and could allow them to better avoid the NVB. Using the second robot proved safe, producing no complications in these patients, and showed that three-dimensional imaging of the prostate and NVB was possible.

Misop Han, M.D., an associate professor in the Department of Urology at the Johns Hopkins University School of Medicine and the study leader, says he and his colleagues plan to test this technology in a larger group of prostatectomy patients. “We’re hoping to continue to refine the images we generate during surgery to ultimately better preserve sexual function,” Han says. His team's study, entitled “Tandem-Robot Assisted Laparoscopic Radical Prostatectomy: Clinical Feasibility Study for Neurovascular Bundle Visualization,” won a top award at the Engineering and Urology Society (EUS) meeting this weekend in Chicago, Il.