State-of-the-art Surgery

RICH ADDICKS / COX NEWS SERVICE Dr. Nikhil Shah (left, staring into viewfinder) as he gets a high-definition look at a patient's prostate during surgery with the da Vinci machine at St. Joseph's Hospital in Atlanta. Surgical assistant Karl Csepi is in the foreground. Hunched over a huge gray console that looks like a giant video game, Dr. Nikhil Shah presses his face against the viewfinder of a da Vinci robot, eyes glued to a 3-D image of the gooey insides of a man's abdomen. His forefingers and thumbs twist twin joysticks that control tiny bird-beak snippers.

Through his magnified viewer, he uses the microtools that look huge to him to probe, push aside and cut threadthin muscles, nerves and veins with precision in a prostate cancer patient lying on a gurney, 10 yards away.

All the while in his stocking feet, he's pumping foot pedals under the console like a piano maestro.

The 90-minute operation is successful.

Patients spend only one night in the hospital, instead of three or four the old-fashioned way.

It's one of the reasons robotic surgery using the $1.5 million da Vinci machine is exploding, especially for prostate surgery. It's also being done increasingly for other intricate operations — ranging from kidney removal to hysterectomies and cardiac bypasses.

Shah said the robots usually allow surgeons to prevent the side effects men and their sexual partners dread most — impotence and incontinence.

His patients, like Dan Fernandez, call him "the rock star" of prostate surgery "because there are so many advantages of this technique."

He scheduled the surgery, was discharged the next day, suffered little pain and has only a half-dozen tiny scars.

Not all men are as lucky, but most operated on by surgeons using the da Vinci robot return to normal within a matter of months, Shah said.

The robotic procedure is only one choice in what Dr. Brantley Thrasher, spokesman for the American Urological Association, calls a "bewildering'' array of prostate treatments. The AUA (www.auanet. org) has no clear guidelines, and its literature makes decisions tough. Each method has strong advocates.

Prostate cancer, the second most prevalent form of the disease in men after lung cancer, is treated with total gland removal, with or without the surgical robot. Other methods include external beam radiation, inserted radioactive seeds, hormone therapy and cryotherapy, or freezing of the organ.

Studies haven't yet pinpointed "the best method," said Thrasher, who uses the robot at the University of Kansas.

Worldwide, 55,000 da Vinci prostatectomies were done last year, and it's expected to hit 75,000 in 2008, said James Alecxih of Intuitive Surgical of Sunnyvalle, Calif., which makes the robots. In 2007, 13,000 robotic hysterectomies were done worldwide; that's expected to hit 32,500 this year.

Shah, who has performed more than 1,000 robotic procedures, said the robots offer many advantages. Their tiny 3-D high-definition cameras magnify the insides of the abdomen, making tiny veins look like small cords. It makes it easier to spare critical nerves, resulting in "significantly better" erectile function than other procedures, he said.