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Da Vinci Robotic Surgery at UCW

On this Page

  • The 1st robotic surgeons in Westchester
  • What is robotic surgery?
  • Da Vinci Prostatectomy at the Urology Center of Westchester
  • Our Da Vinci surgeon, Dr. John Phillips
  • Da Vinci Partial Nephrectomy
  • Nerve-Sparing Athermal techniques

Led by Yale- and NIH-trained Dr. John Phillips, we provide the latest in robotic minimally invasive surgery using the Da Vinci HD S robotic surgery platform. Our physicians were the first to perform a Da Vinci robotic procedure in Westchester and the Hudson Valley area. We have performed over 200 robotic procedures to date and expanded its use to include:
  • Da Vinci (Athermal) Nerve-Sparing Prostatectomy (NSP)
  • Robotic Partial Nephrectomy
  • Total Pelvic Exenteration
  • Adrenalectomy
  • Cystectomy for bladder cancer
  • Hysterrectomy
  • Myomectomy
  • Ureterectomy
  • Pyeloplasty for UPJ obstruction
  • Lymphadenectomy, retroperitoneal (RPLND)
  • Sacrocolpopexy for bladder support

What is robotic surgery?

The robot used in robotic surgery is an extension of laparosopy, a minimally invasive or 'keyhole' surgery which inserts small (8 mm wide) instruments in the body as opposed to making a large incision. The robot allows the insertion and control of instruments which are very similar to the human hand and allow the surgeon to see in 3-D.

What does the robot do?

The Da Vinci robot is technically a marginal manipulator: it performs only what a surgeon directs the robot to do through robotic arms that duplicate the actions of the human wrist and hand but on a small space.

Why the robot?

Robotic surgery allows the surgeon to perform a minimally invasive surgery with improved visualization, dexterity, and ease.

Components of the robotic platform.  The surgeon, sits at the console where the 3-D images are transmitted. From the chair, the surgeon controls the camera, and two (sometimes three) robotic hand pieces. On the Right, an assistant is at the patient's side where the robotic arms carry out the commands of the surgeon.

"Components of the robotic platform. The surgeon, sits at the console where the 3-D images are transmitted. From the chair, the surgeon controls the camera, and two (sometimes three) robotic hand pieces. On the Right, an assistant is at the patient's side where the robotic arms carry out the commands of the surgeon

Robotic Prostatectomy

Phillips We have performed Da Vinci Prostatectomy (DVP) since 2001, and were the first group to offer the technology in the Hudson Valley area. Our robotic surgeon, Dr. Phillips (left) was trained at Yale and the National Institutes of Health, and has been a Da Vinci robotic surgeon since 2003 and thus represents the longest robotic surgery experience in Westchester. He is the Chief of Genito-Urinary Oncology at Westchester Medical Center.

What is a Da Vinci Prostatectomy?

For many men with prostate cancer, DVP is an excellent option whose two main goals are to
  • cure cancer
  • preserve quality of life
The Da Vinci Robotic System is a revolutionary surgical tool that has allowed surgeons to perform minimally invasive prostate cancer surgery with many benefits over traditional 'open' surgery. Potential benefits of robotic surgery include: robotic
  • Decreased bleeding and need for transfusions
  • Less Pain
  • Quicker Recovery
  • Shorter Hospital Stays
  • Precise surgical control
  • Improved 3-Dimensional Visualization
  • 270 wrist-like range of motion
Click here to download a Da Vinci Prostatectomy (DVP) Patient brochure provided by Intuitive Surgical, or go to the DVP website at www.davinciprostatectomy.com

Why a Da Vinci Prostatectomy?

The prostate is located in a small area of the lower pelvis, between the bladder and urethra, in front of the rectum. It is surrounded by delicate tissues, muscles, and nerves, including the nerves for erections. Preserving these nerves and muscles are critical to preserve erections and normal urination. The Da Vinci robot allows us to see these delicate structures, remove the prostate safely, and preserve urinary and sexual function after.

What is a nerve sparing prostatectomy?

Erections occur because fine nerves called cavernosal nerves from the lower spinal cord send signals to the penile tissues to being the erectile response. As the cavernosal nerves run down to the penis, they course over the sides and back of the prostate gland. To preserve erections after prostate cancer surgery, these fine nerves must be saved while removing the prostate. A nerve-sparing prostatectomy (NSP) accomplishes this; a non-nerve sparing prostatectomy (non-NSP) does not. Many men are candidates for NSP:
  • erections are OK before surgery
  • cancer is low volume
  • risk of residual cancer disease is low
We now understand that NSP must be performed without the use of electrocautery, a common surgical tool, which can injure the cavernosal nerves with heat. An athermal NSP must therefore be performed. prostate removal

What is an athermal NSP?

Athermal robotics means that where delicate, heat-sensitive structures like the erectile nerves are located, no heat or electrocautery is used during surgery. A Da Vinci Prostatectomy allows us to perform an athermal NSP because of the enhanced visualization and robotic range of motion that renders electrocautery unnecessary.

What are the steps of DVP?

DVP surgery is performed under general anesthesia so that the prostatic area is completely still. Antibiotics and heparin are administered 30 minutes prior to incision.
dvp 1.The robotic arms are placed through 8 mm incisions
2.The prostate is identified
3.The seminal vesicles and the vas deferens are identified
4.The blood vessels to these structures are clipped
5.The erectile nerves are identified and pushed away
6.The dorsal venous complex is divided
7.The urethra is divided
8.The prostate is removed
9.The urethra and bladder are reconnected
10.The tissues over the bladder are replaced
11.A catheter is inserted
12.The robotic incisions are closed

What about after DVP?

  • One should expect to stay overnight in the hospital after DVP or until good bowel function has resumed
  • Days 1-6: Rest at home; no driving is allowed; gentle walking without weights is encouraged. A urinary catheter is worn for 7 days, a simple device worn under loose fitting trousers.
  • Day 7: Office check up. The catheter is slipped out. Incisions are checked; prescriptions are reviewed. Return to work timing is discussed. You may drive if you are taking no pain medications.
  • Day 7-14: No lifting > 10 lbs; no deep bending or twisting at the waist. Walk 5-10 minutes/day
  • Weeks 3-6: Urinary incontinence continues to improve with gentle walking and Kegel exercises. Your doctor may ask you to take prescription medications to help with early return of erections.
  • Week 6: Office check up. PSA check, assessment of erectile activity and urinary control.
  • Office visit schedule: every 3 months 1st year; semi annually x 3 years, and annually thereafter.
Kidney tumors are often small and do not require removal of an entire kidney. Sometimes, a small tumor can be removed while saving the remaining kidney in an operation called a "partial nephrectomy". The incision required to reach the kidney can be large and painful, between the 11th and 12th ribs or below. At the Urology Center of Westchester, we have used robotic technology to perform partial nephrectomy since 2007 with minimally invasive techniques. Robotic partial nephrectomy allows for a faster recovery with the delays and problems associated with traditional flank incisions. See a video below of a routine robotic partial nephrectomy we performed for a left sided kidney tumor.

The adrenal glands are paired, apricot pit-sized endocrine organs positioned on top of each kidney. The adrenal glands are critical in keeping us alive by regulating our blood pressure, circadian rhythm, and response to stress. The adrenal glands can, however, form tumors, mostly benign, but which make hormone levels that are too high. Our urologists are published, international speakers on adrenal diseases and their treatment. We can tell which tumors can be simply observed or need to be removed. When surgery is required, we use laparoscopic, robotic, and minimally invasive techniques to ensure a rapid recovery and superior results. Here is a recent video of our performing a robotic-assisted adrenal removal for a blood pressure producing tumor called a "pheochromocytoma".

Further links and resources