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Moffitt Docs Use Robots For Surgery
By Bill Swisher
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Dr. Julio M. Pow-Sang doesn’t mind if some of his patients describe the care they’ve received as “robotic.”
In fact, Pow-Sang, who chairs the Department of Genitourinary Oncology at Moffitt Cancer Center, is a big fan of using robots in surgery for prostate
cancer, the most common type of cancer in men.
“All of the prostate surgeries we do at Moffitt are robotic, and around the country it’s been increasing since the technology became available in 2002,”
said Pow-Sang, who is also director of the Moffitt Robotics Program.
Robotic procedures are generally less invasive than traditional, “open” surgeries. They typically involve less blood loss and offer the patient a much
shorter recovery time.
“Robotics takes advantage of a procedure called laparoscopy, which requires different skills from open surgery and is somewhat more difficult because
one has to operate through a little ‘keyhole’ in the abdomen. It’s like operating with chopsticks,” Pow-Sang said.
Surgeons tried removing the prostate through laparoscopic surgery alone in the early 1990s, “but it was very tough. And then robotic consoles became
available, providing the technology to enhance the skills of the surgeon doing laparoscopy.”
Now, instead of standing next to a patient “and basically doing acrobatics” to manipulate the laparoscopic instruments, the surgeon sits at a desktop
console “and is thinking about the surgery more than working to do the surgery,” Pow-Sang said. “The robot does most of the work.”
But surgery is only one treatment option for men with prostate cancer, he said. Another choice is radiation therapy, which comes in many forms. Among
the major types, available at Moffitt:
In fact, Pow-Sang, who chairs the Department of Genitourinary Oncology at Moffitt Cancer Center, is a big fan of using robots in surgery for prostate
cancer, the most common type of cancer in men.
“All of the prostate surgeries we do at Moffitt are robotic, and around the country it’s been increasing since the technology became available in 2002,”
said Pow-Sang, who is also director of the Moffitt Robotics Program.
Robotic procedures are generally less invasive than traditional, “open” surgeries. They typically involve less blood loss and offer the patient a much
shorter recovery time.
“Robotics takes advantage of a procedure called laparoscopy, which requires different skills from open surgery and is somewhat more difficult because
one has to operate through a little ‘keyhole’ in the abdomen. It’s like operating with chopsticks,” Pow-Sang said.
Surgeons tried removing the prostate through laparoscopic surgery alone in the early 1990s, “but it was very tough. And then robotic consoles became
available, providing the technology to enhance the skills of the surgeon doing laparoscopy.”
Now, instead of standing next to a patient “and basically doing acrobatics” to manipulate the laparoscopic instruments, the surgeon sits at a desktop
console “and is thinking about the surgery more than working to do the surgery,” Pow-Sang said. “The robot does most of the work.”
But surgery is only one treatment option for men with prostate cancer, he said. Another choice is radiation therapy, which comes in many forms. Among
the major types, available at Moffitt:
● Brachytherapy, or putting internal radiation pellets into the prostate, also called
seeding.
● Temporary-implanted high-dose radiation, a newer technique described as
“putting needles in the prostate, but instead of dropping seeds, ‘flashing’ the radiation,”
Pow-Sang said. “More and more places around the country are starting to use this,
because there is some discussion of whether it is as effective as the seeds but without
the side effects, which are mainly related to urination.”
● Permanently-implanted seeds, which Pow-Sang describes as—putting in a needle,
flashing the radiation, and taking the needle out.”
All these forms of radiation therapy can be done alone or in combination, Pow-Sang said.
● Cryosurgery, also known as freezing. It’s not widely available since the outcomes aren’
t as well established as other forms of treatment “because not a lot of patients have been
treated with it,” he said.
● Active Surveillance, formerly called watchful waiting. “This is a systematic way of
following the patient, reading the PSA every so often and doing a biopsy every so often,”
Pow-Sang said. This treatment is used for non-aggressive cancers as long as the patient
is comfortable. “The underlying philosophy is that it spares unnecessary treatment for
men who don’t need it.”
seeding.
● Temporary-implanted high-dose radiation, a newer technique described as
“putting needles in the prostate, but instead of dropping seeds, ‘flashing’ the radiation,”
Pow-Sang said. “More and more places around the country are starting to use this,
because there is some discussion of whether it is as effective as the seeds but without
the side effects, which are mainly related to urination.”
● Permanently-implanted seeds, which Pow-Sang describes as—putting in a needle,
flashing the radiation, and taking the needle out.”
All these forms of radiation therapy can be done alone or in combination, Pow-Sang said.
● Cryosurgery, also known as freezing. It’s not widely available since the outcomes aren’
t as well established as other forms of treatment “because not a lot of patients have been
treated with it,” he said.
● Active Surveillance, formerly called watchful waiting. “This is a systematic way of
following the patient, reading the PSA every so often and doing a biopsy every so often,”
Pow-Sang said. This treatment is used for non-aggressive cancers as long as the patient
is comfortable. “The underlying philosophy is that it spares unnecessary treatment for
men who don’t need it.”
The future of therapy, he said, will involve a better definition of just how aggressive a particular patient’s prostate cancer is, “to determine which prostate
cancer patients need to be treated and which ones we can leave alone, at least for some period of time.”
In addition, one key to individualized treatment may lie in an area known as epigenetic markers—chemical additions to the genetic sequence of DNA that
occur following replication and that may help clinicians determine the characteristics of each individual cancer.
“The technology is available; we just have to find the combination that will tell us that because this patient has a particular genetic profile and these
epigenetic changes have some [corresponding] profile, we know that particular patient will respond very well to hormonal therapy and we can treat him that
way. Or another patient might need a different type of treatment instead.”
cancer patients need to be treated and which ones we can leave alone, at least for some period of time.”
In addition, one key to individualized treatment may lie in an area known as epigenetic markers—chemical additions to the genetic sequence of DNA that
occur following replication and that may help clinicians determine the characteristics of each individual cancer.
“The technology is available; we just have to find the combination that will tell us that because this patient has a particular genetic profile and these
epigenetic changes have some [corresponding] profile, we know that particular patient will respond very well to hormonal therapy and we can treat him that
way. Or another patient might need a different type of treatment instead.”
| Dr. Julio M. Pow-Sang |