Robotic Surgery

The departure of Tok Guru, Datuk Nik Abdul Aziz Nik Mat, after his long battle against prostate cancer had brought sadness to a Kelantanese like myself, and many more Malaysians.

On the other hand, the widely publicised robotic radical prostatectomy for Singapore’s Prime Minister Lee Hsien Loong has highlighted the susceptibility of men to such cancer and the importance of early detection.

In recent years, several prominent politicians suffered prostate cancer. The late South African president Nelson Mandela was diagnosed with the cancer at the age of 83 and had recovered after undergoing irradiation.

Other prominent politicians, who include former secretary of state Colin Powell, and New York mayor Rudy Giuliani, were treated for the male cancer and has since become vocal supporters of prostate cancer awareness.

I am not apologetic for writing about cancer in the midst of Chinese New Year as I think time is crucial in cancer treatment. On that note, let’s deal with one reader’s concern over prostate cancer.

Dear Dr G,

I am 58 and had been diagnosed with early stage prostate cancer six months ago.

The surprising thing is, I have absolutely no symptoms and the cancer diagnosis had come as a shock after a routine PSA blood test.

My wife and I had been to many specialists for opinions and they had given us much information. The treatment options offered include radiations and surgery.

As I am relatively young, most of the doctors had recommended complete removal of the gland to prevent recurrence.

I confess, the thought of the operation had troubled me. I imagined the procedure to be complex and life threatening.

However, having read about Prime Minister Lee’s operative schedule of one week sick leave and back to work after a major operation so quickly, I would like to find out about robotic radical prostatectomy.

I think I am ready to face the operation after Chinese New Year.

I just have a few questions about the cancer and the robotic surgery.

Why is the cancer affecting so many Asians these days? I thought this is predominantly a Western disease?

How on earth is robot doing the operation? What should I expect after the op?

Please Help,

Richard

Prostate cancer incidence and mortality in most Asian populations have gradually increased in the last two decades, however, it is still one third lower than our Asian American cousins.

Although genetic and environmental factors such as western diet had been incriminated for the disparity, the lower life expectancies in the East and less exposure to PSA screening in Asian populations, might be other contributory factors.

Admittedly, prostate cancer had been extensively researched in the last forty years; the true natural history of this disease is still a mystery.

On one hand, the autopsy studies had confirmed most men would be affected by prostate cancer in his life, if they live long enough.

The fact is, the vast majority of men die with prostate cancer rather than of prostate cancer.

Therefore, the key in managing prostate cancer is not just early identification and treatment, it is also important to tease out the men more likely to be affected by the disease.

The landmark breakthrough in prostate cancer treatment undoubtedly is the introduction of robotic radical prostatectomy.

In fact, in many countries, such intervention is considered the gold standard, which provides the lowest risk of morbidity and mortality, as the arms of the robot allows access to the depth of the pelvis where the conventional open surgery is not possible.

It is not the wandering robots in the hospital chasing after the prostate for operations that most people imagined.

The machine is actually a three-arm devise with small articulate instrument to replicate the surgeon’s wrist movements in the surgical fields that allows accurate and steady operations.

The instruments have seven-degree motion compared to four-degree keyhole operations. Of course, with the modern technology, the software that eliminates hand tremors, with the benefits of 3D magnifications, also aids the surgeon.

The post-operative recovery of robotic surgery can be short with minimal “down-time”. Care is also necessary during the recuperation period to prevent complications such as bleeding and infections.

Although most of us may not be as “tough” as PM Lee with only a one week break during Chinese New Year to recover from such a major operation, it is really not impossible to be out of the hospital within 24 hours and back to light duties within a fortnight.

One of the deterrents of prostate interventions is erectile dysfunction and urinary incontinence, as the organ is closely linked to the intricate male bodily functions.

The benefit of robotic accuracy also ensures nerves and muscular preservations, crucial for the sexual functions and continence. Therefore many studies have also highlighted better outcomes in these aspects.

The father of western medicine Hippocrates of Kos, once said: “Healing is the matter of time, but sometimes also matter of opportunity.”

Although Chinese New Year may not be an appropriate time to talk about cancer, the elimination of taboo and open discussions are important factors to help men deal with prostate cancers.