What is Robotic Urology Cardiac Surgery?

Surgeon on Robotic Console

Robotic System-daVinci Telemanipulation Robotic Cardiac Surgery is performed with the help of da Vinci telemanipulation system (Intutive Surgical, Inc, Mountain View, California, USA). The da Vinci system is computer enhanced system that consists of surgeons console and cart mounted manipulators.

Robotic Cardiac Surgery works well for several types of operations (such as gall bladder removal and knee repairs) where parts of the body to be operated upon motionless and surgical maneuvers to be performed are relatively simple. Thus endoscopic surgery has achieved only limited success in more complicated operations such as heart surgery, where the heart is beating and the necessary surgical maneuvers are complex.

The console houses the display system showing three dimensional pictures of the patient's chest cavity, the surgeon sits away from the patient at the console and gets the view of inside of the patient's chest cavity. The manipulators hold the tiny instruments which go inside the patient's chest. Surgeon's hand movements are transmitted to these instruments facilitate different cardiac operations. Coronary artery bypass grafting (CABG), mitral valve repairs and closure of a trial septal defects have been performed successfully through this technique.

IMA LAD Anastomosis with Robotic Instruments

T-CAB (Totally Endoscopic Coronary Artery Bypass) T-CAB is performing Coronary artery Bypass totally endoscopically without opening the chest at all. T-CAB is performed with the help of computer assisted robotic technology (da Vinci telemanipulation system). The robot is not autonomous. On the robotic console surgeon's hand motions are captured, transformed and then transmitted to tiny instruments inside the chest cavity to perform complicated cardiac procedures. The surgeon's had movements are transmitted to tiny instruments that facilitate and endoscopic anastomosis. The control is so perfect that cardiac surgeons are able to construct an anastomosis in the customary fashion without placing a hand inside the chest cavity. The surgeon sits at a console, peering into the chest with 3-dimensional vision and working with perfection. This technique has great cosmetic advantage as there are only 3-incisions, each only 1 cm in diameter on the side and lower part of chest instead of long cut in the front of the conventional surgery. A smaller incision (cut) also means less pain, faster healing and recovery and short hospital stay. For more Information: http://www.fortisescorts.in/services-treatment/robotic-surgery

What is Robotic Urology?

Fortis Escorts Heart Institute has recently launched the Urology and Prostate Centre of Excellence. This centre has resources for state-of-the-art diagnostic testing and treatment for prostate and other urological problems.

Range of treatments available:

TURP for prostate enlargement Laser surgery for prostate enlargement HIFU for prostate cancer Robotic surgery for prostate cancer Penile implant for erectile dysfunction

The Urology and Prostate Centre of Excellence at Fortis Escorts Heart Institute is led by Dr. Ashish Sabharwal, who is a leader in the most advanced and minimally invasive treatments for prostate problems.

Patient centered care:

We strive to provide each patient and family member with education, support and world-class medical care extending from his first visit until discharge. We are also proud to provide personal services (including a free concierge service for out-of-state patients) that put the comfort and well-being of urology surgery patients before all other considerations. Superior Outcomes: The centre has resources for state-of-the-art diagnostic testing and treatment for any type of prostate issue.

Latest Advances:

We provide the most advanced treatments for treating prostate cancer including Robotic Surgery and HIFU (High Intensity Frequency Ultrasound) treatment for prostate cancer.

Our Working Philosophy:

In addition to offering ground-breaking technology, our surgical program provides patients with the advantage of an on-site multi-disciplinary team of anaesthesiologists, intensivists, cardiologists, electrophysiologists, interventional radiologists, vascular surgeons, advanced practice nurses, nurse practitioners, dietitians, physical therapists, and social workers. This team often expands to include immediate care from on-site physicians from every medical specialty required. Our multi-disciplinary approach and expertise has gained us the reputation of being the best-prepared surgical practice to handle procedures that may be complex and/or complicated by underlying illness or age. Know more:- http://www.fortisescorts.in/department/urology

FAQs
What are prostate problems?

The prostate is a walnut sized gland found only in men. It sits just below the bladder and surrounds the urethra, the tube that carries urine from the bladder out through the penis. Its function is to make fluids for semen. The prostate gland grows naturally with age, usually without problems. In some men, as the prostate gets bigger, it may squeeze or partly block the urethra. This often causes problems with urinating. This is called benign prostatic hyperplasia (BPH). With advancing age and in some younger men with a strong family history, the prostate becomes cancerous. In fact, prostate cancer is the MOST COMMON CANCER among men and the second leading cause of death in men. The prostate also at times is the site of infection and this condition (PROSTATITIS) is common in younger and middle aged men.
What is benign prostatic hyperplasia (BPH)?

As a man ages, the prostate can grow larger. When a man reaches the age of 40, the prostate gland might have increased from the size of a walnut to that of an apricot. By the time he reaches the age of 60, it might be the size of a lemon. Because it surrounds part of the urethra, the enlarged prostate can squeeze the urethra. This causes problems in the passing of urine. Typically, these problems passing urine don't occur in men until they are age 50 or older. They can, though, occur earlier. An enlarged prostate is also called benign (noncancerous) prostatic hyperplasia or BPH. It is common and cannot be prevented. Age and a family history of BPH are risk factors. Eight out of every 10 men eventually develop an enlarged prostate. About 90% of men over the age of 85 will have BPH. About 30% of men will find their symptoms bothersome.

Symptoms of an enlarged prostate may include:

trouble starting to urinate (hesitancy), or urinating freely having to urinate frequently, particularly at night (nocturia) feeling that the bladder is not empty after urinating feeling a sudden urge to urinate (urgency) having to stop and start repeatedly while urinating (intermittency) having to strain to urinate

To maintain prostate health, it is important for men who have early symptoms of BPH to see their doctor. BPH is a progressive disease. It can lead to serious, although rare, health problems, such as kidney or bladder damage. Know more:- http://www.fortisescorts.in/department/urology
What causes BPH?

Benign prostatic hyperplasia is probably a normal part of the aging process in men, caused by changes in hormone balance and in cell growth.
How is BPH diagnosed?

Your doctor can diagnose BPH by asking questions about your symptoms and past health and by doing a physical exam. Tests may include a urine test (urinalysis), a blood test (serum creatnine), and a digital rectal exam which lets your doctor feel the size of your prostate. In some cases, a prostate-specific antigen (PSA) test is done to help rule out prostate cancer. (Prostate cancer and BPH are not related, but they can cause some of the same symptoms.)
Screening for prostate Cancer - the PSA Test and The Digital Rectal Examination

According to the American Cancer society, Men aged 50 and older, and those over the age of 45 who are in high risk groups, such as African-American men and men with a family history of prostate cancer, should have a PSA test and digital rectal exam (DRE) once every year. Prostate-specific antigen (PSA) is a substance produced by the prostate gland. Elevated PSA levels may indicate prostate cancer or a noncancerous condition such as prostatitis and enlarged prostate. Most men have PSA levels under four (ng/mL) and this has traditionally been used as the cutoff for concern about risk of prostate cancer. Men with prostate cancer often have PSA levels higher than four, although cancer is a possibility at any PSA level. According to published reports, men who have a prostate gland that feels normal on examination and a PSA less than four have a 15% chance of having prostate cancer. Those with a PSA between four and 10 have a 25% chance of having prostate cancer and if the PSA is higher than 10, the risk increases to 67%. In the past, most experts viewed PSA levels less than 4 ng/mL as normal. Due to the findings from more recent studies, some recommend lowering the cutoff levels that determine if a PSA

value is normal or elevated. Some researchers encourage using less than 2.5 or 3 ng/mL as a cutoff for normal values, particularly in younger patients. Younger patients tend to have smaller prostates and lower PSA values, so any elevation of the PSA in younger men above 2.5 ng/mL is a cause for concern. Just as important as the PSA number is the trend of that number (whether it is going up, how quickly, and over what period of time). This is called PSA velocity. If a persons PSA increases by more than 0.75 ng/ml over a period of 9 months, then patient should undergo prostate biopsy to rule out prostae cancer. It is important to understand that the PSA test is not perfect. Most men with elevated PSA levels have noncancerous prostate enlargement, which is a normal part of aging. Conversely, low levels of PSA in the bloodstream do not rule out the possibility of prostate cancer. However, most cases of early prostate cancer are found by a PSA blood test. Know more:- http://www.fortisescorts.in/department/urology
How to confirm the diagnosis of prostate cancer?- TRUS Biopsy Of the Prostate

The Gold Standard for diagnosis of prostate cancer is Transrectal Ultrasound [TRUS] Guided Prostate Biopsy. This is an out-patient Procedure. The ultrasound probe is introduced via the rectum and mapping of the prostate is done. Then with the help of the biopsy gun, 12 cores are obtained from the prostate and sent for histopathology testing. After the procedure, patients can drive back home without any problem.
How is BPH treated?

As a rule, you don't need treatment for BPH unless the symptoms bother you or you have other problems such as backed-up urine, bladder infections, or bladder stones. If urinary symptoms become more troublesome, then BPH will require treatment. In some cases ,if the prescribed medicines do not relieve the symptoms, surgery may be required. When to call a doctor?

You are not able to urinate Urination is painful Fever over 100oF, chills, and body aches. Lower back pain below your rib cage(flank pain) Presence of blood or pus in your urine or semen A burning sensation while urinating Painful ejaculation

Surgical treatments For Benign Prostatic Hyperplasia

Laser Prostatectomy : This procedure entails the use of high power laser to remove the obstructing prostate. It is done as an outpatient procedure. The patient generally leaves the hospital within a few hours after

surgery. Besides being highly effective in treating symptoms of an enlarged prostate (BPH), its other advantages include, minimal or no pain, minimal blood loss ,no transfusions, short catheter time 1-2 days),and safe for high risk patients and those on blood thinners. TURP Transurethral Resection of Prostate) is the surgical removal of part of prostate gland through an instrument inserted through the urinary passage. Usually requires hospitalization and is done using general or spinal anesthetic. It has slightly higher risk of complications including blood loss. It is not a good option for patients with significant medical conditions and patients on blood thinners. Open Surgery for the prostate: thing of the past. Very rarely used nowadays because of the advent of the Laser. Know more:- http://www.fortisescorts.in/department/urology
Prostate Cancer: Latest Treatments and Emerging Therapies

PROTATE CANCER IS CURABLE IF DIAGNOSED AT AN EARLY STAGE. If you've been diagnosed recently with prostate cancer, you might find the latest treatment options somewhat confusing. Each has its benefits and risks. And no single treatment is right for every man with prostate cancer. Various treatment options are available based on *grade and stage of prostate cancer *Patients age at diagnosis *Life style considerations *Other Important factors
What are the treatment options for early stage prostate cancer?

Robotic Surgery for prostate cancer (Robotic Radical Prostatectomy): Surgical removal of the entire prostate gland by the robotic technique is called Robotic Radical Prostatectomy. Radical Prostatectomy is done to remove the early stage prostate cancer before it can spread to other parts of the body. The benefit of robotic surgery is that there is better vision and control during surgery, so there is minimal blood loss, more complete removal of the prostate cancer, better control of urine and better erectile function post operatively.

What are the alternatives to surgery?

1. HIFU for prostate cancer. HIFU treats localized cancer by focusing high intensity ultrasound waves on the prostate and destroying the prostate .The ultrasound waves are focused onto the prostate through the ultrasound probe that is placed in the rectum (TRUS). 2. Orchiectomy: This means surgical removal of the testicles, resulting in an immediate and permanent reduction in testosterone. The after effects should be discussed thoroughly with your physician.Orchiectomy is considered hormonal therapy because it reduces testosterone levels. In fact, LHRH analogue therapy has been shown to be comparable to orchiectomy in decreasing the bodys supply of testosterone. 3. Radiation for prostate cancer. This is the treatment of choice for those patients who are not candidates for surgery. High doses of radiation can kill cancer cells. The type of Radiation available in India is the External Beam Radiation Therapy. In this technique, radiation is administered to the prostate and other selected tissues with a carefully targeted beam of radiation administered from machines outside the body. 4. Watchful waiting: Another option is watchful waiting. This involves careful observation of the patients condition, without immediate treatment for prostate cancer. This may be an appropriate therapeutic course for men who have less aggressive tumors, which typically grow slowly. 5. Hormonal Therapy: Doctors use LHRHa therapy to slow the spread of cancerous cells and alleviate symptoms associated with advanced prostate cancer. Chemotherapy: This is a common term for cytotoxic drugs used to destroy the cancer. These drugs target and destroy cells that divide rapidly-traits that define some cancerous cells. Unfortunately, chemotherapy also effects normal cells that actively divide, such as blood cells forming in bone marrow, as well as cells in hair follicles, the mouth, and the intestines. Destruction of these normal cells causes side effects . the most common ones are fatigue, nausea and vomiting, diarrhea, mouth sores and a low WBC count. Supportive medication may be given to help offset the side effects caused by chemotherapy drugs. Always consult your doctor to discuss as to which is the best modality in treating your case. Know more:- http://www.fortisescorts.in/department/urology