| David J. Laub, M.D. |
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Experience: Dr. David J. Laub has performed hundreds of radical prostatectomies in his career as a urologic surgeon. In 2002, he was the first urologic surgeon to do a laparoscopic prostatectomy in Santa Barbara. He is now perfecting his ability to use a minimally invasive approach to the surgical removal of the prostate by utilizing the Da Vinci surgical robot.
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 allows the surgeon to view the operative field at high magnification, while maintaining a three-dimensional perspective unlike standard laparoscopic surgery. Amazingly enough, this technology is at the forefront and is currently available for certain Urologic procedures such as the radical prostatectomy (removal of complete prostate gland), nephrectomy (removal of partial or complete kidney), and cystectomy (removal of the bladder). It is also being utilized in other surgical subspecialties such as Cardiac surgery, General surgery, and Gynecologic surgery.
What are the benefits of a robotic prostatectomy? Early experience with robotic prostatectomy suggests that these outcomes are at least equaled to traditional open surgery. Whether robotic surgery results can surpass the already high-quality results of the open radical prostatectomy is still an open question that is being actively investigated. Robotic surgery does appear to offer the patient a reduction in blood loss during surgery, shorter hospital stays, and a less painful, faster recovery and return to normal activity.
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A form of Laparoscopic prostatectomy that utilizes a robot has become the new wave of the future as minimally invasive procedures have become the forefront of technology in the operating room. The Da Vinci robotic system has dramatically enhanced the surgeon's ability to perform minimally invasive surgery with great precision and speed. Instead of the surgeon's hand entering the patient's abdomen, robotic arms are attached to long instruments that are placed through small keyhole openings in the abdomen. These instruments house a tiny camera and surgical tools that permit the surgeon to cauterize and sew tissue similar to having small hands inside the abdomen. The surgeon sits at a console a few feet away from the patient in the operating room with binocular-like lenses enhancing a 3-Dimensional picture giving the surgeon the feeling having the tissue directly in front of him. The robot also improves visualization by magnifying the surgical field by 10x. Dr. Laub is able to guide the robot's work by twisting his wrists in the stirrup-like handles, using his thumbs and fingers in scissor-like loops, or tapping his foot pedals to focus the camera and move the robotic arms. The Da Vinci robot simply follows the command that the surgeon gives it at the console and is therefore a master-slave system alone, not a free-standing system making its own decisions.
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.