ValleyCare Medical Center to integrate robotics for safe and patient-friendly prostate cancer treatment

Santa Barbara 15 November 2000Drs. Mark Avon and Carlos Gracia of ValleyCare Medical Center in Pleasanton, California, successfully used the EVOLVE Surgical Continuum to transition from an "open" surgical prostate cancer treatment to a new minimally invasive surgical treatment. EVOLVE is a revolutionary robotic surgery system, which has been developed by Computer Motion Inc.

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Both surgeons join an extensive network of over forty surgical pioneers at thirty United States institutions who have performed well more than 800 laparascopic radical prostatectomy procedures across the world, employing Computer Motion's robotic technology. This group of pioneering surgeons is driving the adoption of a new minimally invasive approach with robotic assistance and setting it as the gold standard treatment for prostate cancer patients.

Drs. Avon and Gracia performed two procedures through four 5-mm surgical ports in the patient's lower abdomen to remove the cancerous prostate using the Computer Motion AESOP Endoscope Positioner. The AESOP system is a robotic arm that positions the endoscope, a slender camera which is inserted into the patient to view the operative site, in response to a surgeon's simple voice commands. It is the first United States Food and Drug Administration (FDA) approved surgical robot.

According to the National Cancer Institute, prostate cancer affects more than 185.000 American men each year. It is the most common male cancer and is the second leading cause of cancer deaths in men. A radical prostatectomy is the standard treatment for patients diagnosed with prostate cancer.

In a traditional "open" procedure, an eight-inch incision is made in the patient's lower abdomen, in order to remove the prostate and part of the urethra. The conventional approach is associated with significant pain, major scarring and long recovery time with the increased risk of substantial blood loss, impotence and incontinence.

However, at present, it is believed that a laparoscopic approach to a radical prostatectomy can minimise these negative factors. Dr. Avon, a urologist, committed himself to learning this new minimally invasive approach so that he could deliver an effective but less traumatic treatment to his patients.

To ensure his success, he adopted the Computer Motion EVOLVE Surgical Continuum. The EVOLVE programme is especially designed to support a gradient learning curve to quickly and easily develop the endoscopic and surgical skill set required to transition from "open" surgery to more patient-friendly endoscopic procedures.

Dr. Avon first integrated the Computer Motion Alpha Virtual Port, designed with direction from Michael D. Black, M.D., of Stanford University Hospital, into his standard procedure. Utilised in conjunction with AESOP, the Alpha Port aids the surgeon in developing minimally invasive techniques while performing routine "open" procedures.

It creates a virtual endoscopic port for surgeons to begin learning how to work off a video monitor while performing "open" surgery. Dr. Avon commented: "I was able to develop new minimally invasive skills and became familiar with robotics while maintaining a safe and comfortable surgical environment."

Dr. Avon also decided that his learning curve would be reduced if he had a skilled laparoscopic surgeon assisting him. He teamed up with Dr. Gracia, a laparoscopic general surgeon, for these initial cases, which also helped to educate Dr. Gracia on the urologic procedure and patient anatomy.

In October, Dr. Avon attended a training course on the robotically assisted laparoscopic radical prostatectomy with Bertrand Guillonneau, M.D., and Guy Vallancien, M.D., who helped perfect this minimally invasive approach to treating prostate cancer, at the Institut Mutualiste Montsouris in Paris, France.

This course demonstrated that the laparoscopic radical prostatectomy is very safe, feasible, standardised, reproducible and teachable. "AESOP is the enabling technology behind this pioneering minimally invasive treatment option", added Dr. Vallancien.

A laparoscopic approach can take three to five hours to complete, compared to two to three hours for an "open" procedure. The positive impact to patients, however, cannot be overlooked: less blood loss, minimal hospital stays, complete independence from pain medication, as well as the reduced possibility of impotence and incontinence.

"The outcome with a laparoscopic procedure is dramatically different. The patients were walking around the hospital the next day with no reported discomfort", stated Dr. Avon. The learning curve for a new procedure is expected, which can contribute to longer case times for a surgeon's initial procedures. It is noteworthy that the team at ValleyCare was able to perform each of their first two cases in approximately five hours.

"I am convinced that these excellent case times were in part due to the incremental steps we followed with the EVOLVE process", explained Dr. Avon. "We were able to gain the necessary skills to easily develop the endoscopic and surgical skill set required, in order to safely, effectively and quickly perform this new procedure.

"AESOP is an essential tool for this procedure. Both surgeons have their hands occupied and are working at the operating table. There is little room for a third person to position the endoscope for visualisation of the operative site.

"Plus, we were able to work off a perfectly steady operative image, something impossible with a human scope holder. The AESOP system's compact design and seamless voice control interface make for the perfect solution, especially during a long, complex case, which requires delicate manipulations", Dr. Avon added.

Yulun Wang, Ph.D., founder and chief technical officer of Computer Motion, stated: "The early clinical success at ValleyCare is very exciting and encouraging. We believe that leading surgeons around the entire world will continue to use the EVOLVE Continuum to drive the widespread adoption of the new laparoscopic approach to a radical prostatectomy, to finally become a gold standard for prostate cancer patients. The EVOLVE programme offers an easy and economical pathway for the hospital and the surgeon."

Computer Motion is a high-tech medical device company equipping surgeons to enhance life by evolving surgical practices. Computer Motion company develops, manufactures and markets proprietary computer-enhanced and robotic surgical systems, which extend the surgeons' capabilities, improve outcomes and reduce costs. To date, the Computer Motion family of products has safely assisted more than 100.000 minimally invasive procedures across a broad range of surgical disciplines.

Computer Motion's products include the voice-controlled AESOP endoscope positioning system; the HERMES Control Center, a centralised system which allows the surgeon to voice control a network of "smart" medical devices; and the ZEUS Robotic Surgical System for new minimally invasive microsurgery procedures, such as endoscopic, beating heart bypass surgery. The ZEUS Robotic System is CE-Marked for commercial sale in the European Community and is co-marketed by Computer Motion and Medtronic.

Computer Motion has completed an FDA-approved Phase 1 Investigational Device Exemption (IDE) coronary bypass study and has initiated an IDE mitral valve surgery study with the ZEUS System. More information about the different robotic surgery systems which are currently being utilised in Europe and the USA, is available in the VMW July 2000 article Computer Motion to start patent infringement war on medical robotics against Intuitive Surgical.


Leslie Versweyveld

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