Robotic prostate cancer surgery in Michiana - Part 2: The procedure

Video games and surgery do not usually go hand in hand, but that is changing with a minimally invasive laparoscopic prostate surgery and a robot named da Vinci.

Sixty-five-year-old Stan Hynek of Rolling Prairie found out that he had cancer in October.

Stan and his urologist, Dr. Carl Walker, decided robotic surgery was his best option, and they allowed photojournalist Don Schoenfeld and me to follow them into the operating room.

Once he was prepped and said goodbye to his kids, Stan was taken to the operating room.



Dr. Carl Walker and Stan Hynek

After putting six keyhole incisions in Stan's abdomen, Dr. Walker and his team inflated Stan's stomach with CO2.

"We've inflated the abdomen to give us some space to work, and we put in all the instruments through the special trocars," the doctor explained.

That allows Dr. Walker to operate on Stan with tiny, state-of-the-art instruments.

"Most patients will go home the next day after surgery. Usually they'll go home with a catheter that stays in for about a week," Dr. Walker explained.

And while it may seem mind-boggling, after the trocars are in place, Dr. Walker moved across the room to begin performing surgery from a console.

Using his stocking feet, the doctor works a clutch and camera much like you would the gas and brake on a car.



da Vinci's hand controls

His hands move the controls much like a video game.

"You lose the touch, but you gain a lot more rotation and motion, and you also get a nice magnification and a 3D screen," he explained.

That magnification makes the surgery much easier for him because he can better see where and what he is cutting.

"Now we're doing the anterior dissection, and this is dropping the bladder down and getting to the prostate," Dr. Walker narrated.

Using tiny pincher-like instruments, he delicately works his way to the prostate.

Roughly two hours after this delicate surgery began, Dr. Walker continued to work carefully to preserve the nerves surrounding the prostate.

"Layered around the prostate gland is where the nerves lie, and they allow for erections, so we're freeing that bundle so we can push them down and push them away from the prostate gland," he explained.



Dr. Carl Walker

After tedious work, Dr. Walker separated the prostate and noted that it looked intact without any evidence of cancer.

Before removing the prostate, he added an absorbable sling to support the bladder.

"I have been impressed with the early return of continence," he notes. "I think it's worth the extra effort to put it in these gentlemen."

Before stapling down the sling, he worked with precision to reconnect the bladder and urethra, a tedious process again compared to playing video games.

"I'm sure if my 13-year-old knew the anatomy, he could do this quicker than I could," he joked.

With that job done, the sling was finally sutured near the bladder.

It was then time to remove the prostate earlier freed from Stan's body, and the way it was done was nothing short of amazing.

A bag was fed through the trocars and the prostate placed inside. The bag was then pulled out through a hole near Stan's belly button, instead of a long incision down the abdomen.

Finally, the keyhole incisions for the trocars in Stan's stomach were stapled shut.

With Stan on his way to recovery, Dr. Walker gave the family the news they had been waiting for.



Stan Hynek post-surgery

"He did fine, he did fine. He's in the recovery room now," Dr. Walker reported. "We got everything out, put the bladder and urethra back together again. Things looked good when we were done."

Before heading on to another surgery, Dr. Walker checked on Stan, with orders to send him home with Motrin.

Just three weeks later, Don and I visited Stan at his Rolling Prairie home, where he was back to refurbishing his toy tractor collection.

How did he feel?

"Excellent. You wouldn't believe this, but three hours after I was out of surgery I walked a lap in the hospital. Dr. Walker looked at me and said, 'what are you doing?' And I said, 'what does it look like? I'm taking a walk over here,'" Stan recalled.

Stan was able to return to work after two weeks and felt as spry as his canine friend Homer.

We at WNDU want to thank Stan, Dr. Walker, and the team at Memorial for allowing us to witness this incredible procedure.

And Stan wanted us to stress that he did not feel any symptoms before being diagnosed, so it is important to get routine prostate checks -- especially once you reach 50.

If you wait for symptoms, your cancer may not be found until it spreads outside the prostate.

An additional item of interest is a Columbia University study published last year in the journal Cancer. The study followed nearly 3,000 men and found that the robotic procedure offered an improvement over conventional surgery in terms of health and quality of life.


Prostate cancer risk factors:

Age: Once you reach the age of 50, your chance of having prostate cancer increases.

Race or ethnicity: For reasons that are not well understood, black men have a higher risk of developing and dying of prostate cancer.

Family history: If your father or brother has prostate cancer, your risk of the disease is greater than that of the average man.

Diet: A high-fat diet and obesity may increase your risk of prostate cancer. One theory is that fat increases production of the hormone testosterone, which may promote the development of prostate cancer cells.

High testosterone levels: Because testosterone naturally stimulates the growth of the prostate gland, men who use testosterone therapy are more likely to develop prostate cancer than are men who have lower levels of testosterone. Also, doctors are concerned that testosterone therapy might fuel the growth of prostate cancer that is already present. Long-term testosterone treatment also may cause prostate gland enlargement (benign prostatic hyperplasia).


For more information about robotic prostate surgery, visit davinciprostatectomy.com.

To reach Dr. Walker's office at the South Bend Clinic, call 574-243-4450.

To read about the Columbia study titled "Evolution of robotic radical prostatectomy," search for Cancer [2007 NOV 1;110(9):1951-8]


For part one of this series, visit the story titled Robotic prostate cancer surgery in Michiana - Part 1: The preparation




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