By Mary Beth Hislop

It wasn’t too long ago in the timeline of medical advancements that men diagnosed with prostate cancer whose physicians recommended surgery faced an unsettling decision: Remove the prostate and risk a lifetime of incontinence and impotence or leave the cancer alone and risk its spread. For many men, neither choice supports healthful living.

But as much as technology has developed equipment that invades people’s privacy, the growing consensus within the medical community opts toward the opposite end of the spectrum – equipment and techniques that are minimally invasive to a person’s body.

Urologist Dr. Dieter Bruno is a big believer in the da Vinci robot, a surgical system that captures a three-dimensional view magnified 10-15 times the normal size of the surgical field, allowing careful manipulation around surrounding nerve fibers. The robot’s “elbows,” in effect, the surgeon’s hands, can rotate 360 degrees, which allows more flexibility maneuvering surgical instruments inside the body.

Bruno was the first doctor in North Carolina to use the da Vinci system. He has performed approximately 100 prostatectomies since 2004. Now affiliated with El Camino Hospital in Mountain View, Bruno employs the procedure in his practice and mentors other surgeons in the technique. He’d like to convince other urologists that da Vinci is a patient’s best bet over traditional prostatectomies.

“Anyone who’s a candidate for a prostatectomy is a candidate for the da Vinci,” Bruno said.

In traditional prostatectomies, surgeons usually remove the prostate through a large incision in the abdomen. Da Vinci requires five to six small incisions in the abdominal area for the camera and surgical instruments.

“There’s less time recovering, shorter hospital stay, less pain and blood loss,” he said. “A patient will get back to work more quickly.”

Bruno said prostate cancer is the No. 1 cancer in men and the No. 2 cause of men’s deaths.

Last year, the National Cancer Institute estimated 220,000 men would be diagnosed with prostate cancer and 28,000 would die from the disease. African-American men have twice the mortality rates observed in other racial and ethnic groups in the United States, while American men succumbed to the disease at a ratio of 25 per 100,000.

“Environmental, dietary and hereditary factors all play a role in prostate cancer,” Bruno said. “So do age and race … obviously, you have to be male.”

Bruno and the 53-year-old patient allowed this reporter to view a prostatectomy, which demonstrates the use of the da Vinci system. Bruno said each surgery is different – “you learn something new every time” – but the ultimate success is credited to his assistants.

“It’s really a team approach,” Bruno said. “It’s like a symphony. Everyone has a certain role.”

Physician assistant Kristi Leer will be at the patient’s side, holding the camera, placing hemoclips for clamping and dissecting while Bruno works the robot’s arms from the da Vinci console across the room.

“It’s all hand-eye movement coordination,” Leer said. “What he has above all others … he cares about doing the best job. He’s cutting edge.”

Surgery technicians Deanna Donahue and Randy Creamier are also team members who strongly believe in the da Vinci technology.

“This is taking laparoscopy to the next step,” Creamier said of minimally invasive surgical techniques. “This is very quickly becoming the gold standard for prostates.”

Also on hand is an anesthesiologist, Dr. Steve Xanthopoulos, who will monitor breathing, blood pressure, oxygen saturation, heart rate and brain activity, to be sure the patient doesn’t waken.

After the patient is scrubbed, six incisions are made for da Vinci’s arms, CO2 is pumped into his abdominal area to allow camera and instruments to move and the prostatectomy begins. The surgery becomes complicated by extra fat around the bladder that Bruno must cut away and cauterize to reach the prostate. When the prostate is separated from the bladder, it is bagged within the body as Bruno sutures the urethra to the bladder, with a tube inserted for support.

At the conclusion of the procedure, da Vinci’s arms and camera are removed and the bagged prostate is pulled through one of the incisions to be forwarded to the lab. Leer and Bruno work together suturing the patient’s small incisions.

With no additional complications, Bruno usually finishes the procedure in two hours. This operation took three hours and was one of the top 10 most difficult procedures he’s ever done, he said.

Still, “He’ll probably go home tomorrow,” Bruno said.

This is the first article of two. The second article will be published March 19.