Dr David Mcginnis Md Voted Top Docs Philadelphia Magazine
David McGinnis, MD, a Bryn Mawr Hospital urologist, is among the first in the Philadelphia region to remove cancer from the prostate through a minimally invasive procedure called laparoscopic radical prostatectomy.
Only a few centers nationwide are currently performing this procedure. For patients undergoing laparoscopic procedures, there is less pain and quicker recovery than following conventional surgery. Kidney cancer tends to affect both men and women almost equally and tends to affect people in their 40s to 80s with the greatest incidence affecting people in their 60s. Minimally invasive surgery can remove a cancerous kidney just as effectively as traditional open surgery while giving adults, children and infants patients the same long-term survival. The symptoms of kidney cancer typically are a pain in the flank or upper side of your back that doesnt go away, a feeling of poor health, blood in the urine and in some cases, a mass you can feel in the flank.
NEW: Patients will have three small incisions in their side below their ribs for the procedure. The procedure generally takes just between three and four hours and the patient can expect to have a hospital stay of one to two days.
In the article Showing How Hospitals Operate Main Line School Night will introduce medical experts and equipment to students stress-free, The Philly Inquirer Sun, Sep. 16, 2007, Bonnie L. Cook writes:
How Does The Robotic
It is similar to the conventional, minimally invasive laparoscopic prostatectomy. However, working from a special console in the operating room, the surgeon operates four precision-guided robotic arms to cut and remove the prostate. The procedure uses a small video camera, inserted through a keyhole-sized incision to provide surgeons with magnified, 3-D images of the prostate site. This expansive view allows doctors to see the nerve bundles and muscles surrounding the prostate. The robotic arms, with full 360-degree rotation capabilities, are placed through several other keyhole incisions allowing surgical instruments to move with greater precision, flexibility and range of motion than in a standard laparoscopy.
The procedure usually takes 2 to 3 hours under general anesthesia. Most patients experience only a small blood loss and blood transfusions are needed in less than one percent of patients. Prostatectomy patients typically spend one night in the hospital and are usually discharged as soon as their laboratory tests are acceptable, pain is controlled and they are able to retain liquids. Patients are discharged with special catheter, which is removed during an outpatient visit 5-7 days after the operation.
What To Expect After Prostate Surgery
The surgeons at AdventHealth are known for providing excellence in patient outcomes, so you can expect good results from your surgery. After surgery you should plan on:
- Spending one night in hospital. Most patients go home within 24-hours
- Being back to normal activities within 1-2 weeks
- An early return of urinary control and sexual function based on preoperative function
- A short period of catheterization
- A low complication rate
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Lefrak Center For Robotic Surgery And Institute Of Prostate Cancer
The Lefrak Center for Robotic Surgery is dedicated to the care of patients with prostate cancer using innovative MRI based diagnostic and staging approach and provides comprehensive care involving active surveillance, focal therapy, robotic prostatectomy, radiation and medical therapy. The Center has performed over 3500 robotic procedures and its faculty have published extensively about their outcomes in peer reviewed literature. For more information visit .
The Da Vinci Robotic 3d Camera
Standard laparoscopic viewing utilizes one single camera and limits surgeon’s vision to a 2-D view similar to watching your da Vinci 3D display image television. The da Vinci robotic camera consists of TWO high resolution fiber optic cameras. Like your eyes they produce a true 3 dimensional color picture available to the surgeon seated at the da Vinci console by viewing the twin high resolution, high frame-rate eyepieces. Endoscope picture Magnification of up to 10-12x can be achieved with these cameras. These components constitute the Insite Vision System, by Intuitive Surgical, one of the most advanced vision systems available. A central robotic arm positions the camera and lighting exactly where the surgeon wishes it, because it is operated by the surgeon by foot pedals as he/she is comfortably seated at the console. Also note the camera can be placed within 2 inches of the prostate during robotic surgery. Two different cameras are also available: straight, and 30 degree oblique. The oblique camera can allow the surgeon to peek around the corners and to partially see underneath the prostate.
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Disclosures And Important Safety Information
Surgical Risks
Risks associated with radical prostatectomy include leaking of urine, urgent need to urinate, cannot get or keep an erection, rectal or bowel injury, narrowing of the urethra, pooling of lymph fluid in the pelvic area or legs.
Important Safety Information
Patients should talk to their doctor to decide if da Vinci® Surgery is right for them. Patients and doctors should review all available information on non-surgical and surgical options and associated risks in order to make an informed decision.
Serious complications may occur in any surgery, including da Vinci Surgery, up to and including death. Serious risks include, but are not limited to, injury to tissues and organs and conversion to other surgical techniques which could result in a longer operative time and/or increased complications. For Important Safety Information, including surgical risks, indications, and considerations and contraindications for use, please also refer to www.intuitive.com/safety.
Individualsâ outcomes may depend on a number of factors, including but not limited to patient characteristics, disease characteristics and/or surgeon experience.
da Vinci Xi® System Precaution Statement
Medical Advice and Locating a Doctor
Surgeons experienced with the da Vinci System can be found using the Surgeon Locator. Intuitive Surgical provides surgeons training on the use of the da Vinci System but does not certify, credential or qualify the surgeons listed in the Surgeon Locator.
During Your Hospital Stay
Once your surgery is over, you will be taken to the recovery room, where your post-operative care will start. You will be there for at least one to two hours. The skilled nurses will monitor your vital signs to ensure you wake up properly and are stable after surgery. Once you have woken up and have met the recovery rooms criteria for discharge, you will be transported to your private room, where you will spend the remainder of your hospital stay. Your family and friends will then be told to which room you are going and where to wait. Due to COVID-19 restrictions we encourage you to contact our hospital concierge for the latest visitor guidelines by calling .
The nurses that take care of you have been specially trained in robotic prostatectomy surgery and understand the special attention you need and what needs to be done to optimize your care.
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What Are The Benefits To A Patient
The surgery usually includes removing the prostate, seminal vesicles and ends of the vas deferens. For intermediate and high-risk patients, the pelvic lymph nodes are also removed. Patients typically experience significantly less pain and less blood loss than those undergoing conventional open incision procedures. Patients also tend to enjoy quicker recovery times. A traditional, open radical prostatectomy requires two days hospitalization and recovery lasting about 2 months. With robotic-assisted surgery, the recovery time is as little as 2-3 weeks. Depending on age and health, most patients can also expect to have their potency return with or without the use of oral medications.
Minimally Invasive Prostatectomy In San Diego
If your doctor has recommended you have a prostatectomy, its natural to have concerns. Our patients often ask if prostate surgery will affect their bladder control or sexual performance. But you can rest assured knowing prostatectomy is safer and less invasive than ever before and in many cases, it saves lives.
Scripps surgeons perform many prostate surgeries every year. Whenever possible we use the latest minimally invasive techniques, including robotic prostatectomy.
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Surgeon Console For Robotic Prostate Surgery
The surgeon operates while seated comfortably at the da Vinci Surgeon Console, an ergonomically designed console viewing a 3-D image of the operative site. As the surgeon moves his hands, wrists and fingers, the instruments are performing the same movements inside the patient’s body. The da Vinci Robotic System is able to scale the doctor’s motions and translate them to the operating arms during robotic prostate surgery.
* Minimal Blood Loss With Da Vinci Robotic
The average estimated blood loss per patient averages 116 cc. This volume is roughly the 1/3 of the volume of a 12 oz. soda can. Estimated Blood loss has ranged for robotic patients from 25cc to a maximum of 400 cc in the 1st 100 patients. Because of these low blood losses, none of these men required a blood transfusion, nor were they asked to donate autologous blood prior to surgery.
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What Happens If There Is A Malfunction During The Da Vinci Robotic Surgery
In the unlikely event of malfunction during the robotic surgery, or if the surgeon feels that it is not safe to continue with the robot, the da vinci system will be withdrawn and the surgery can proceed either via traditional laparoscopic means or via traditional open radical prostatectomy. The instruments and supplies necessary are kept on hand such that conversion, if necessary, can occur seamlessly. Dr. Ahlering was previously an expert in open radical prostatectomy such that good surgical results can still be obtained in this unlikely event.
Performing The Robotic Prostatectomy: A Prostate Cancer Surgery General Overview For Patients
The essence of minimally invasive prostate cancer surgery is to gain access to the involved anatomy via the smallest entry points possible. Traditional open prostatectomies involved cutting open the lower abdomen with a large incision. Predictably, large incisions in traditional surgery for prostate cancer run a higher risk of infection and require significantly more time for the patient to heal, not to mention they tend to leave a large scar. Laparoscopic techniques however, using the da Vinci Robot, bypass this large incision and gain the same access through a few small holes in the skin, each roughly the size of a dime. A small plastic tube known as a “port” is inserted in each hole to keep a channel open for laparoscopic Port Placement image tools to reach through. To allow room inside for the surgeon to work, the abdomen is inflated slightly with carbon dioxide like a balloon. In this working space, the surgeon can perform the same surgeries as if the abdomen had actually been cut open, but without the large incision.
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Surgery For Prostate Cancer : Introduction
Radical prostatectomy has been performed as an open surgery for quite some time with good success, however as minimally invasive surgery has evolved, it has become possible to perform radical prostatectomies laparoscopically. Recent leaps in technology with the advent of Intuitive Surgical Inc.’s da Vinci robot have taken radical prostatectomy past laparoscopy to an all new level of success. In the hands of a skilled surgeon like Dr. Ahlering, of UC Irvine Medical in Orange County, this new tool allows the radical prostatectomy to be performed minimally invasively with greater precision and ease to both the patient and the surgeon than ever before.
Risks Of Prostate Surgery
The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:
- Reactions to anesthesia
- Blood clots in the legs or lungs
- Damage to nearby organs
- Infections at the surgery site.
Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.
If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.
In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.
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How Is The Da Vinci Surgery For Prostate Cancer Performed
Sitting at the robots surgical console, the surgeon performs robotic prostatectomy by controlling the device consisting of:
- high-resolution cameras
- micro-surgical instruments.
Powered by state-of-the-art robotic technology, his hand movements are scaled, filtered, and seamlessly translated into the precise movement of the EndoWrist Instruments.
Side Effects Of Robotic
The rates of major side effects from robotic-assisted laparoscopic radical prostatectomy are about the same as open surgical approaches. The most common side effects include the following:
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Urinary incontinence : Similar to open surgery, urinary incontinence can occur following a robotic prostatectomy. However, this side effect often improves over time.
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Erectile dysfunction : The return of erectile function following prostatectomy is based on the patients age, degree of preoperative sexual function and whether the nerves were spared during surgery. Unless cancer is suspected in the nerve tissue, surgeons will use nerve-sparing techniques during robotic prostatectomy to minimize the surgical impact on sexual function.
Robotic Prostate Surgery | Q& A
Thanks to advances made by surgeons like Dr. Patrick Walsh, The Brady Urological Institute at Johns Hopkins offers unparalleled prostatectomy expertise. Learn more about prostate cancer surgery and the difference between open and robotic procedures from Dr. Mohamad Allaf.
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What Are The Patient Criteria For Robotic
The decision to surgically treat prostate cancer involves many considerations. UC Davis urologic surgeons will discuss your treatment options and help you decide the best course of action. Nearly all patients diagnosed with localized prostate cancer will have the option of choosing robotic-assisted surgery. It is the now most commonly selected prostatectomy approach in the United States. Patients with significant abdominal adhesions or obesity, however, may not be appropriate candidates for the this procedure.
Da Vinci Prostatectomy Benefits
The da Vinci robotic system offers several advantages over other prostatectomy techniques:
- 3-dimensional high magnification camera with true color
- More precise control of surgical tools, with small hand shaking filtered out
- Reduced surgeon fatigue
- Better control of blood loss, which allows the surgeon to see more clearly during the procedure
- Ability to make cleaner and more refined cuts in the area of the prostate
- Smaller incisions
- Faster recovery, including control of urine
- Shorter hospital stay
Every surgery carries potential risks, including da Vinci prostatectomy. They include:
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Bryn Mawr Urology Now Brings The Da Vinci Robotic Surgical System Which Performs Remote Telerobotic Surgery
The da Vinci system consists of three components:
- a surgeon console with an integrated three-dimensional display stereo viewer
- a robotic manipulator with three cartmounted arms
Visualization is obtained by two three chip cameras mounted within one integrated, three-dimensional 12 mm stereo endoscope with two separate optical channels. The laparoscope is controlled by moving the master robotic handles. The operative images are transmitted to a high resolution binocular display at the surgeon console. Unique laparoscopic instrument tips, called Endo wrist instruments, provide articulated motion with a full seven degrees of freedom inside the abdominal cavity. Tip articular mimic the up/down and the side-to-side flexibility of the human wrist. Instrument tips are aligned with the instrument controllers electronically to provide optimal hand-eye orientation and natural operative capability.
Dr. Mcginnis said, A current standard treatment for prostate cancer is radical prostatectomy, in which an eight-inch incision is made in the patients lower abdomen to remove the prostate. The clear advantages of performing this procedure laparoscopically are decreased pain, quicker recovery and less bleeding, he explained. The future of surgery is to become less invasive and limit the side-effects of treatment, and this is a big step in that direction.
Da Vinci Surgery For Prostate Cancer: What Is It Benefits Etc
The development of modern technology has allowed doctors to treat many diseases with minimal harm to your health. Thanks to the development of medical tourism, you can easily undergo minimally invasive treatment of cancer abroad.
One of the best countries in applying modern treatment methods is Turkey. Many hospitals in Turkey have robotic surgical systems, such as CyberKnife and Da Vinci. In Turkish clinics, da Vinci surgery for prostate cancer is especially popular due to its effectiveness and safety. A pleasant bonus of Turkey is its low prices for treatment with a high level of medical services.
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What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible
There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.
For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.
These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.
Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.