Welcome Video Part 1
Dr. Randy Fagin: I am Dr Randy Fagin with the Urology Team. I am going to talk today about Da Vinci robotic surgery. This is in my opinion one of the most exciting advances in the field of medicine today. It is not just changing the way surgery is performed, it is changing patient outcomes, it is a brand new way of experiencing surgery.
In the next 30 minutes we will discuss this amazing new technology, the potential it has to produce exceptional patient outcomes, my own nerve sparing techniques and inside look at the Da Vinci. Let's talk about how this remarkable technology can produce the potential for exceptional patient outcomes.
It is an amazing piece of equipment. What does it actually do for patients? What does it do for surgeons? What's the value of this amazing piece of technology? It doesn't want us do the surgery any faster, the way it works in the console is, my hands actually hold on to the pieces or robotic equipment and as they move, my movements are duplicated as robotic movements. No better, no worse, no fast or no slower, just duplicate it. What it does though is it allows me to filter my movements. What that means is larger movements of my hand can actually be smaller movements of the robot. That means larger movements can be turned into finer detail. It is truly remarkable to letting me do a surgery with greater precision that even my own hands are capable of. If I can see it better, if I have a more precise tool to do the operation with, then I can create a better patient outcome. Because I as a surgeon control the camera, control the instruments, control my own working arms as well as an assistant arm, I am actually in more control of the entire operation. Specifically I am able to do less manipulation of tissue, I don't need to move the anatomy around to meet my instruments, I can actually articulate my instruments to meet the anatomy. Less collateral damage means better patient outcomes, faster recovery.
We have a lot of data on Da Vinci robotic surgery. It has been around for years. Probably one of the best comparative studies that I have seen, and the first one that was done was at Henry Ford Hospital where they looked at high volume open surgeries and high volume robotic surgeries and looked at their outcomes. And the outcomes have been measured for any prostate cancer operation will include things like negative margin rates for cancer control, urinary control recovery, sexual function recover, time in the hospital, time to regular activities, number of pain killers utilized, pain scores, amount of blood loss, blood transfusions, and every one of these categories in Henry Ford's data, robotic surgery exceeded the outcomes for open surgery. And it is not just their data. As we are seeing more and more surgeons adopting to Da Vinci robotic surgery across the nation, we are seeing that data repeated again and again, especially in the hands of the high end users, people who are doing the high volume of Da Vinci robotic surgery. One of the ways that I try and work to consistently create better outcomes in my patients is by tracking my data. In an analysis we not just see the good things but also the bad things and how to make it better. I consistently work to [] techniques and better outcomes to create some standard of care for our patients. When we look at open surgeries in comparison, open surgery has always been the gold standard for prostate cancer treatment and robotic surgeries had to meet those standards that open surgery has been able to create. And as we look at that data over time of robotic surgery, thousands and thousands of cases over and over again we are seeing that we are creating a new standard of care for our patients. Our expectations are changing and patient's experience with prostate cancer will never be the same. The most important thing for the patient obviously is removal of the cancer. This is a cancer operation, and the way that we measure our cancer surgery is by a negative margin rates. When the prostate surgery is done, that specimen goes to pathologist. We take it whole and they get to look at the entire thing and tell us where is the cancer, did the cancer come up to the edges of what we removed, basically how good a cancer operation did we or didn't we do. When we look at the negative margin rates for patients with robotic surgery, in the hands of people who do a high volume of this operation, we are seeing the exact same negative margin rates as we would see with an experienced open surgeon. So essentially in the best of hands, robotic surgery is providing as good a cancer operation as the best open surgery, which is our current gold standard.
So a urologist eventually perform the procedure this way if it is creating a new standard, shouldn't that everybody be doing it. Answer, is no. Every urologist will not eventually perform Da Vinci robotic surgery. It is a highly complicated operation. It requires not only a high level of commitment to it, and a high level of dedication to those surgical techniques that takes thousands and thousands of hours, hundreds and hundreds of patients to actually achieve. One of the things that makes my own patient experience unique is the way that I got to this point. For the past two years I performed over 200 Vinci robotic surgeries per year. I have a total experience of over 700 laparoscopic and Da Vinci robotic prostate cases. It is one of the largest experiences in the nation. But it didn't come that way all of a sudden. I had the privilege of training with the originators of laparoscopic prostate surgery in Paris, France back in 2000 when they first developed the technique. And I was able to spend the next two years performing laparoscopic prostate surgery without the help of the Da Vinci robot. When the robotics came on board we were excited to be able to then offer that our patients and it has literally exploded in growth ever since. That is one of the reasons why I was asked to create an international training center for robotic surgery here in Austin. It is one of the reasons why I lecture across the United States and overseas. It is one of the reasons why patients and surgeons come to see me from all over the United States and all over the world. We have patients who come from Houston, from Hong Kong, from Virginia, from Venezuela, our patients literally come from all over the planet to come here and the reason is we try to be very innovative with the very exciting new technology.