Dr. Jihad Kaouk, MD, FACS, Director of Robotic Surgery at the Glickman Neurological Institute talks about a new robotic surgery for the treatment of prostate cancer.
Interview conducted by Ivanhoe Broadcast News in June 2022.
KAOUK: Robotic surgery is an excellent application for patients with prostate cancer to remove the cancer and the prostate. The surgery is done through a robot that has multiple arms. That means every arm holding an instrument will need a cut. It’s called keyhole surgery. So, you do the surgery through small holes. Most recently, a purpose-built robot was introduced – a new generation of robots that have one cannula. So, one cut. Through that comes all the instruments and camera. So, only one cut in the belly of the patient to perform the surgery of removing the cancerous prostate. What’s different is not only the new robot, what we did, we got the new robot and modified the surgery, the steps of the surgery itself, so that we can minimize the pain and quicken recovery for the patient. What we did in principle was to regionalize this surgery to where the disease is. So, we don’t go through the belly anymore to get to the prostate. We go through the bladder where the prostate will be just there, and we do the surgery from inside the bladder. That’s why the new approach is called transvesical radical prostatectomy. Transvesical means through the bladder robotic prostate surgery. We found that by working just from inside the bladder, we don’t touch the bowel. We don’t see the bowel. The patient has quicker recovery. They go home within four hours.
Who would be eligible for a procedure like this?
KAOUK: There are definitely, like any other procedure, inclusion and exclusion criteria. So, the surgery, this kind of transvesical approach, is good for patients who have a cancer that’s not very aggressive, moderately aggressive, a prostate that can be large but not too large. So, if it is four or five times the usual size, then it becomes too crowded of a space to work inside the bladder. So, we don’t use this approach for that. These are the two main limitations. One big advantage going through the bladder are for patients who have what we call hostile abdomen. That means they’ve had so many surgeries through their belly that build up a lot of scar tissue. So, if you would go through the belly the traditional way, they are at risk of bowel injuries and other problems and complications. So, we avoid all that area by going through the bladder. You don’t see any of the scar tissue. You see the prostate. For the hostile abdomen, multiple previous surgeries, the transvesical approach seems to be a very effective way.
Are you one of the few hospitals in the area offering this? Is this a relatively rare procedure to be performed in hospitals?
KAOUK: We were the first to use single port applications in the United States. Back in September of 2018, we got the very first system. We started with the traditional way of doing the robotic prostatectomy, and then we refined the technique to what I was just explaining to you. There are a few centers that started around the country now following, but we are the people who pioneered the procedure at the Cleveland Clinic. And now we are publishing the outcomes that, as I shared with you, is very exciting.
What advice do you have for individuals who might be dealing with prostate cancer in the early stages? Is this a conversation they need to have with their doctor about this procedure being available?
KAOUK: Yes, absolutely. There are always several options to treat the prostate cancer. One of them is surgery and within surgery, there are different approaches. There are at least five different approaches to remove a cancerous prostate surgically. This should be discussed as one of them. Because if the patient is a good candidate, they will benefit from a quicker recovery. Also, for those who have a lot of previous abdominal surgery, this can be, on some occasions, even safer to do.
Anything else you wanted to mention about the procedure and your involvement?
KAOUK: I would like to say that we’re excited about innovations at the Cleveland Clinic. We consider ourselves as the hub of innovations that bring value. This procedure is not just to introduce something new. Our focus is about the value it brings. And here, the value from the single port would be for the patient quicker recovery, less collateral damage. For the surgeon, offering an additional option so that we can custom tailor our approach to patients and give them the best possible approach. And for the health system, because with patients being outpatient, we have for the same number of beds more space to touch more lives and serve more patients.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Hope Buggey
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here
