In October 2004, Dr Kella completed his year long fellowship in urological oncology and robotic surgery under the guidance of Kevin Slawin at Baylor Medical School in Houston, Texas. He was raised in Dallas, Texas, but received his Bachelor degree in Chemical Engineering from Stanford University before returning to Texas to begin his medical school training at the University of Texas, Southwestern Medical School in Dallas. His surgical internship and urological residency were completed at Tufts School of Medicine in Boston, Massachusetts. He intends to set up his practice in the Midland/ Odessa area, where his wife, Reema, spent most of her formative years.

Nick Shroff

Nick Shroff spent 5 years (from 1972 to 1977) on the staff of Cook County Hospital, Chicago, Illinois where he did his surgical training, Urology Residency and urology (oncology) Fellowship. He is Board Certified in both adult and pediatric urology and has been a Diplomat of the American Board of Urology since February 1979. He has been running a private urology practice in Midland since August 1980. At Midland Memorial Hospital, he was on the Board of Trustees 1996-2000, Chief of Staff 1994, Chief of Surgery 1991. He was also Chief of Surgery 1982/83 at both the Physician and Surgeon Hospital and Parkview Hospital.

Our Surgeons and Robotic Surgery

This is a description of radical prostatectomy using robotic surgery. Surgeons, Naveen Kella and Nick Shroff, using the da Vinci™ surgical robot, successfully performed two cases at the Alliance Hospital in Odessa, Texas. At this time, this is the only surgical robot available in the West Texas area. Both patients were able to go home on the second postoperative day and had complete removal of their cancer.

What is robotic surgery?
For selected patients, surgical removal of the prostate gland, along with the prostate cancer, can be performed using a laparoscopic approach. "Laparoscopic prostatectomy" offers the benefits of a minimally invasive approach to surgery. These benefits generally include: reduced pain, shorter hospital stays, and a faster recovery. While these advantages are attractive, surgeons and patients alike need to make sure minimally invasive techniques can offer equal or surpassing standards for cancer control, urinary control, and sexual potency, already established by open surgery.

The arrival of robotic technology has dramatically enhanced a surgeon's abilities to perform minimally invasive surgery with precision and speed. With the da Vinci robot system, the surgeon is seated comfortably a few feet away from the patient at a control console, while the assistant stands by the operative table. Surgery is performed through 4 "key holes" (tiny) incisions, like standard laparoscopic surgery. However, the robotic instruments, about the diameter of a pencil, have wrist-like maneuverability, allowing the surgeon to move them like his own hand, as opposed to standard laparoscopic instruments, which have a much more limited range of motion. The advanced optics allow the surgeon to view the operative field at high magnification, while maintaining a three-dimensional perspective, unlike standard laparoscopic surgery. Finally, the dexterity of the surgeon's hand is enhanced by the robotic system, scaling motion to allow microsurgical movements, unequaled with either open or standard laparoscopic surgical approaches.

Overview

The Surgeon Console: Using the da Vinci™ Surgical System, the surgeon operates while seated comfortably at a console viewing a 3-D image of the surgical field. The surgeon's fingers grasp the master controls below the display with hands and wrists naturally positioned relative to his or her eyes. The technology seamlessly translates the surgeon's hand, wrist and finger movements into precise, real-time movements of our surgical instruments inside the patient.

Patient-side Cart: The cart provides the three or four robotic arms - two or three instrument arms and one endoscope arm that execute the surgeon's commands. The laparoscopic arms pivot at the 1-cm operating ports eliminating the use of the patient's body wall for leverage and minimizing tissue damage. Other surgical team members assist in installing the proper instruments, preparing the 1-cm port in the patient, as well as supervising the laparoscopic arms and tools being utilized.

EndoWrist® Instruments: A full range of instruments is provided to support the surgeon while operating. These instruments are designed with seven degrees of motion that mimic the dexterity of the human hand and wrist. Each instrument has a specific surgical mission such as clamping, suturing or tissue manipulation. The instruments are small and typically, fit within the circumference of a dime. Quick-release levers speed instrument changes during surgical procedures.

InSite® Vision System with high resolution 3-D Endoscope and Image Processing Equipment: This component provides the true to life 3-D images of the operative field. Operating images are enhanced, refined and optimized using image synchronizers, high-intensity illuminators and camera control units.

What are the potential advantages of robotic prostatectomy?
With open radical retropubic prostatectomy, results have steadily improved over time. Early experience with robotic prostatectomy suggests that these outcomes are at least equal to open surgery. However, robotic surgery does offer the patient a reduction in blood loss during surgery, shorter hospital stays, a faster and less painful recovery and quick return to normal activity.

What are the potential drawbacks of robotic prostatectomy?
Our expectations are that robotic surgical results will at least equal and even surpass these results. The relative newness of the procedure should be considered when making a decision regarding what is best for any individual patient. While hospital stays and recovery time are reduced with robotic prostatectomy, the time spent in the operating room is often longer than with standard open radical prostatectomy.

Am I a candidate for robotic prostatectomy?
There are many excellent options available to patients for the treatment of localized prostate cancer. We try and tailor treatment for each individual patient that matches each unique circumstance. Ideal patients are of normal weight, without extensive prior abdominal surgery or radiation therapy, with a less extensive cancer burden in the prostate.

Outcomes after robotic prostatectomy
We are actively studying patient outcomes undergoing this procedure. Recently, Dr. Kella reported his excellent cancer control rates, equivalent to open surgery, with robotic prostatectomy. A video of his technique was recently accepted for presentation at the 2004 American Urological Association Annual Meeting in San Francisco, CA.

He has adopted new robotic surgery techniques that allow performance of the surgery without actually entering the abdominal cavity. We believe this makes the surgery safer for the patient and speeds the patient's recovery after surgery. This allows him to return to normal activity and work more rapidly and, down the road, avoids potential complications related to intra-abdominal surgery for the patient. Furthermore, Dr. Kella has now demonstrated in a new study, soon to be published, that he has maintained with robotic laparoscopic-assisted radical prostatectomy, our low positive margin rates traditionally seen with our mini-incision open radical prostatectomy technique.