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back to article Robotic surgeon successful in first prostate snip

A man suffering from cancer has become the first Briton to have his prostate removed by robotic surgery. Stuart Ellis, from Cheadle Hulme, had his prostate removed by surgeons at Stepping Hill Hospital in Greater Manchester using a handheld robotic device called Kymerax, which is used via keyhole surgery to deal with …

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Science.....

...it works.

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It's not a robot.....

... it's a remote manipulator, fully controlled by the surgeon.

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Re: It's not a robot.....

Came here to say that.

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Re: It's not a robot.....

To be additionally pedantic, it's a human surgeon, using a purely mechanical device.

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Coat

Re: It's not a robot....."Where's Waldo"?

I don't think I want the answer!

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Anonymous Coward

I remember when my were disconnected.

the nurse had heard all the jokes.

But what was funniest, is that a friend of mine told me my doctor wouldn't put me forward for the op, until she'd seen my wife (which happened,) and that, the information pack would say there are a small percentage of men have spontaneous reconnection, (even though the non ball end is stitched up, and that was true as well.) This made me think that the doctor ensured men's wives know so they can stop having affairs, and that the spontaneous reconnection was to give stupid men something to believe when their wives got pregnant afterwards.

When I coughed as the doctor grabbed my balls, the nurse practically held up a laminated card saying, "You coughed because you think you're original. Well you're not."

Still it could be worse. My brother in law got Melonitis.

(That's where they swell up like Melons.)

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Re: I remember when my were disconnected.

> spontaneous reconnection

The article is about a prostate removal, not a vasectomy.

It's about tackling a different sort of unwanted growth.

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Anonymous Coward

I think I'd rather a robot went up my rectum

than a surgeon's hand up to the wrist

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Paris Hilton

Re: I think I'd rather a robot went up my rectum

We're so lucky to get free fisting on the NHS in this country!

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Re: I think I'd rather a robot went up my rectum

I've booked a visit from Asimo for you. Honda are sending him around tomorrow with an economy tub of vaseline.

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Happy

Re: I think I'd rather a robot went up my rectum

Asimo?

Why not Mr Psycho from Robot Wars?

Grapes peeled and crushed.

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can it do the "nerve sparing" removal

that's great. can it do the nerve-sparing version of that operation, that leaves you a happier camper when it's done?

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Unhappy

'First' prostate snip???

Pahh!!

here's one we made earlier... in about 1995 and even featured on Tomorrow's World.

Imperial College's Probot

This was a true active robot, once the region to be removed was marked out on ultrasound scans, the robot chuntered away removing that region itself.

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Thumb Up

Re: 'First' prostate snip???

I was just about to post a comment that I thought this story was bogus as I worked ona film back in the 90s that showed a British robot doing a prostate op in a London Hospital - Yes, a BRITISH robot.

Glad that someone can verify that I did't dream it.

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Re: 'First' prostate snip???

Royal Berks in Reading has also been doing "robotic" prostectomy, I too wonder what's new about this particular operation.

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Terminator

Rise Of The Machines?

Had to be said.

I''ll get me coat, its the leather Terminator one.

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Anonymous Coward

Re: Rise Of The Machines?

As I'm reaching that sort of age I can honestly say I don't want any machines rising there...

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Facepalm

Re: Rise Of The Machines?

Your attitude is the most sensible on here: practically all men over 60 and certainly all over 70 have cancerous cells in their prostates. It's a disease of age - get over it.

Cancerous prostate cells only turns nasty if you let urologists get near them with instruments: after that, all bets on a long life are off. Just ask any oncologist (cancer specialist). Urologists do this for profit, because in the USA they can get away with it, even though all other medical advice is against letting anyone near your prostate.

A dead patient is unlikely to complain, and the odd few that survive this assault on their manhood deperately need to convince themselves that their lives have been saved. Anything else calls into question why they should allow themselves to be rendered impotent and/or maimed.

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Re: Rise Of The Machines?

@Shocked Jock

Cancerous prostate cells only turns nasty if you let urologists get near them with instruments [Citation needed]

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Re: Rise Of The Machines?

@ Shocked Jock,

Apologies in advance for getting all serious but having worked in Prostate Cancer Research I can't help it.

While you are right that most men over 60 do have some cancerous cells in their prostates (50% of men in their 50s -> 80% of men in their 80s http://info.cancerresearchuk.org/cancerstats/types/prostate/incidence/ )

and that the majority of these men will not be severely effected by those cells 1:26 men will still die from prostate cancer and every year over 4000 men in the UK UNDER 60 are diagnosed with prostate cancer (http://info.cancerresearchuk.org/prod_consump/idcplg?IdcService=GET_FILE&dID=279764&allowInterrupt=1).

As the treatment for prostate cancer are not pleasant and surgery often leaves men impotent and incontinent anything that improves surgical outcomes is potentially life altering for the men involved. Men don't talk about prostate cancer, so research into treatment and detection is a decade behind breast cancer.

Visit CRUK's website (http://info.cancerresearchuk.org/cancerstats/keyfacts/) or the Prostate Cancer Charities site (www.prostate-cancer.org.uk) for more information

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Bronze badge

Re: Rise Of The Machines?

It is often said that you are more likely to die with it than of it and there have been suggestions that it is used to boost survival rate stats (if you screen for prostate cancer you will find it and the people who have it won't die from it as often as with other cancers).

But that is not to say that it never needs surgery.

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Re: Rise Of The Machines?

Yes, you are more likely to die with it than of it, but your consultant will usually be unable to predict which of those categories you are likely to fall into. The younger you are when diagnosed, the more likely that you will die of it rather than with it.

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Go

Behind ... in more ways than one

http://www.davinciprostatectomy.com/index.aspx

You Britishers are just sooooo behind the curve on this. No pun intended of course.

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Anonymous Coward

Re: Behind ... in more ways than one

If Intuitive Surgical haven't actually licenced the technology to Terumo, I'm surprised they've let them get away with this.

The Kymerax laparoscopic tools look almost identical to the laparoscopic parts of the da Vinci, but with hand controllers where the da Vinci parts would normally slot into their robot arms.

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Anonymous Coward

Just be nice

to your robot - not only do they never forget, they tell each other how you treat 'em

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Coat

"can do things not physically possibly with a human wrist "

Hmm..

Something for the ladies.

I feel my absence being requested.

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"Low-cost robot could save NHS millions..."

...As thousands of people hastily decide they DON'T really need operations after all.

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Unhappy

More a tele-operated manipulator.

Lets face it the surgeon's union will *never* let *any* operation be done on a human that does not use a surgeon in the loop. There will always be *some* reason why it just *cannot* be automated.

Remember that cutting people up used to be a side job of the local *barber*.

The fight to allow fully automated surgery (and the potential *massive* reduction in resulting health care costs) will make the fight over the introduction of computerized typesetting (which UK print unions resisted on national newspapers resisted for *decades* after it was SOP elsewhere) will look like a spat over the last piece of cake in a children's birthday party by comparison.

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Re: More a tele-operated manipulator.

I seem to remember that the Imperial College robot mentioned above was fully hands free once it was programmed.

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Silver badge

Re: More a tele-operated manipulator.

Ivan, yes it was. The link I put in the earlier post to Imperial College gives an overview of the design and operation of our Probot prostate resection robot.

As we were doing this about 16-17 years ago (in fact, I came into the project part way through its progress and it actually started something over 20 years ago) it was quite early on in the history of surgical robotics when a variety of approaches were being tried - and in the case of the Probot we chose hands-free operation.

One of the observations of the surgical pilot study we did with it was that some surgeons were reluctant to let go of the robot once they had steered it into the prostate and locked its position ready to start the surgery - it's quite a leap of faith to let go and leave it to get on with things!

More recent surgical robots that we worked on at Imperial College (and indeed, I still work on) were geared to a more cooperative approach between the surgeon and the robot - something we called 'hands-on robotics' or 'active constraints' whereby the robot knows the volume of material that needs to be removed, but rather than moving on its own, the surgeon pushes the robot's tip (or 'end-effector') around (typically the cutting device), but when he or she reaches the edge of the cutting volume the robot pushes back preventing the cutting tip from moving outside of the surgery volume.

By the way, Ivan, you weren't the Tomorrow's World reporter who covered the Probot were you?

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Anonymous Coward

Re: More a tele-operated manipulator.

Well, the surgeons wouldn't have much say in the matter if the anaesthetists pushed for it.

However, it's rather like a plane: you want a human for when the computers go wrong (and hope they're competent when it happens).

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Unhappy

Re: More a tele-operated manipulator.

"More recent surgical robots that we worked on at Imperial College (and indeed, I still work on) were geared to a more cooperative approach between the surgeon and the robot - something we called 'hands-on robotics' or 'active constraints' whereby the robot knows the volume of material that needs to be removed, but rather than moving on its own, the surgeon pushes the robot's tip (or 'end-effector') around (typically the cutting device), but when he or she reaches the edge of the cutting volume the robot pushes back preventing the cutting tip from moving outside of the surgery volume"

So having built a robot it then operates as effectively a remote manipulator with a set of software limit switches on it's motion.

I accept the problems of automated surgery are *formidable*. The Australian experience with their sheep shearing robot would have warned of that (and that was only working on the surface of the body). Patients come in all shapes and sizes. They move (hopefully not too much) when your working on them and in extreme cases their bits might be in the wrong place to the standard model (EG the heart).

*difficult* certainly but not beyond the bounds of modern hardware give the amount of information that can be collected and analyzed *before* you start work coupled with the ability to scale manipulator size to whatever would be most convenient.

We're still centuries away from the autodoc of Niven & Pournelle, but *not* because of technology.

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Re: More a tele-operated manipulator.

"So having built a robot it then operates as effectively a remote manipulator with a set of software limit switches on it's motion."

Not really - for the 'hands-on' philosophy, the surgeon's hands are on the surgical tool itself, so the surgeon maintains direct contact with the tools and patient. Since the tool is connected to the robot, as the surgeon manipulates it, it backdrives the robot and the robot senses the position of the tool and forces applied to determine whether and how much it should push back to keep the tool within the correct area.

"Patients come in all shapes and sizes. They move (hopefully not too much) when your working on them and in extreme cases their bits might be in the wrong place to the standard model (EG the heart)."

Surgical planning can be done from scans of the patient for true patient specific surgery to take into account the variation in shapes and sizes and bits not conforming to the standard model. And, yes, bits of patient do move during surgery, but there are tracking devices that can monitor that and update the plan to take into account the movement (admittedly easier for orthopaedic surgery where we're talking about solid objects than for soft tissue which can distort).

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Unhappy

Re: More a tele-operated manipulator.

"Not really - for the 'hands-on' philosophy, the surgeon's hands are on the surgical tool itself, so the surgeon maintains direct contact with the tools and patient. Since the tool is connected to the robot, as the surgeon manipulates it, it backdrives the robot and the robot senses the position of the tool and forces applied to determine whether and how much it should push back to keep the tool within the correct area."

My use of terminology has been inexact. I had presumed there was some kind of force feedback built into the system.

For those of a certain generation we'd call this a Waldo. A force-feedback teleoperator (now with added computerized limit stops).

"Surgical planning can be done from scans of the patient for true patient specific surgery to take into account the variation in shapes and sizes and bits not conforming to the standard model. And, yes, bits of patient do move during surgery, but there are tracking devices that can monitor that and update the plan to take into account the movement (admittedly easier for orthopaedic surgery where we're talking about solid objects than for soft tissue which can distort)."

That's sort of my point. While those points *could* have been used to argue "Robots are just not flexible enough to handle the real time problems of internal surgery in real time." But I'm not current on the SoA and was not certain this was the case yet.

You seem to be saying that those factors can be taken into account *today*.

No one denies that a modern Surgeon is a highly skilled (and highly rewarded) medical professional.

It's perfectly clear that the ability to deliver *consistent* reliable surgical procedures at reasonable speed and cost will bring about a revolution in the profession. This is obvious to anyone thinking about the social consequences of new technology.

I'm quite sure the surgical community is fully aware of what has happened historically to jobs whose core skills are manual dexterity and eye/hand co-ordination and been de-skilled by automation. The core skill of a printer was their ability to read a page of hot lead set text back to front and upside down (or not if they worked for the Guardian). Now it's a niche skill used by a small group of people who still do things that way for customers who still *want* it done that way.

It's a clever bit of mechanical engineering and (to a layman) very non-intuitive in design, which *might* reduce surgical trauma and improve stay times in hospital.

However had the goal of full automated surgery been pursued from the project in 1997 I would expect they would have a working robot surgeon by now.

I remain a pessimist about the *full* application of the technology. My original point stands. Surgeons will resist *full* person-out-of-loop fully computer controlled surgery more vigorously and longer than the Fleet Street print unions resisted the introduction of journalists being able to set their own type.

No one wants to take a status or pay cut but you don't see much hot metal being used in *any* newspaper anywhere these days.

I'll get excited when a person can be handed over to surgical team *minus* the surgeon and they run a full operation. I'd settle for one that takes 2x as long as a human (to begin with) but has a higher *average* success rate due to its better consistency.

To anyone thinking such resistance is unethical as a violation of their training to do the best for their patient I would point out that a robot surgeon eliminates the need to *be* a patient of a human surgeon so it's not like they are blocking an improvement to patient care or more cynically Turkeys don't vote for Christmas.

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Coat

Keyhole surgery?

More like peehole surgery... yeah I know, I'll get my coat!

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Joke

Can't believe no one's done the obvious.

Robot prostrate surgery.

"your ass in their hands."

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+1 for robotics, -1 for evidence-based medicine

Apart from the fact that most prostate operations are completely unnecessary, that's great news!

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Pint

Snip all hu-mans

Do we have the makings of a Futurama episode here?

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Paris Hilton

Beancounter alternative

How much does it cost to do without the machine thing?

How much does it cost to do with the big machine thing if the operation is a success?

How much does it cost to do with the big machine thing if the operation goes horribly wrong?

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Frightening level of ignorance in some of these posts

There seems to be a fairly widespread view that the route for prostate removal is via the rectum. That may be the site of physical examination of the prostate, but the prostate is generally removed via an incision next to the navel. Also, while prostate cancer tends to be fairly non-aggressive while enclosed within the prostate, it gets very nasty once it escapes. Anyone who is in denial about prostate cancer is playing Russian roulette with their lives. My advice to any men over 50 is to make sure you have a regular PSA test. It is no laughing matter.

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Robots today...

Sharks with lasers tomorrow......I already know shark oil is used in a certain well known suppository as an excipient.

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We've been doing these surgeries in the rather backward area I live in the US for about 2 years, although the million dollar robot is used. The operations are substantially longer than the version using a large incision, although the post-op pain is better and recovery faster. The robotic version also requires the patient to be placed in an extreme head-down position during surgery, leading to fluid accumulation around the face, tongue swelling, and increased risk of breathing problems after anesthesia.

Ignore the poster who says prostate CA is nothing to worry about. True, most elderly men have evidence of the beginnings prostate CA. The problem is that it is difficult to determine whether abnormal prostate cell growth will spread or not. Death by prostate CA is rather unpleasant (it likes bone, and can cause terrible back pain and fractures).

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