Dr. Dean: The
da Vinci Procedures
Dr. Dean explains the Robotic Advantage
Through Dr. Dean's 25 years of clinical practice he has striven to bring to his patient care in urology cutting edge technology that would enhance his patients' surgical outcomes to achieve optimum results. In order to bring this to his practice he has been dedicated to learning and growing.
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After visiting Dr. Mani Menon in 2005, the urologic surgeon who pioneered the use of robotic technology in radical prostatectomy, Dr. Dean saw the elegance in what robotics offered for this difficult operation.
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Dr. Dean saw the transition from a radical extirpative operation (as it had been done in the past) to a robotic operation that was reconstructive. He saw for the first time that an operation that has significant anatomical problems such as incontinence and impotence could be changed to one where the patient could come away from the procedure with the same sensations he had not prior to the operation.
Robotic technology affords the user transparency that robotic technology is all about.
The prostate dwells deep in the pelvic basin behind the bony pelvic ring.
But robotic technological advantage does not stop with improvement of seeing the operative field.
- This anatomical position makes it difficult to access the structure for removal.
- But even more significant is the anatomical fact that the nerves responsible for erection are often distributed over the lateral aspects of the prostate.
- These anatomical planes were exceedingly difficult to visualize in past open prostatectomies, but due to the lens system (eyes) of the robot, the surgeon can visualize these planes not only in 3D but with 10X magnification and with the capability of zooming in and out of the visualized operative field.
- These lens system characteristics create together a tremendous technological surgical advantage when doing the prostatectomy.
- Because the operative field is seen so well that planes to unveil the nerves off the lateral surface of the prostate produce maximized results with respect to potency and probably continence.
- In Dr. Tewari's series 54% returned to intercourse at three months and 82% were sexually functional at nine months with or without aid.
The hand movements of the surgeon are transmitted precisely to the working instruments that are being viewed at the visualized operative field. Now areas that were once difficult to work in such as under the pubic symphysis for the bringing together of the bladder and urethra (anastomosis) now become freely accessible to the operating surgeon. This has become a huge advantage for patients lucky enough to have their prostatectomy done robotically.
Because now in three large reported series of robotic radical prostatectomies the complete continence rate (no pads - complete dryness) is 96%.
There have always been difficulties with scar in the area of the anastomosis in open prostatectomies, but this is virtually a thing of the past now with the robotically performed anastomosis.
But there is even more that robotic technology offers. Because the areas are hard to access placing sutures can be difficult, but the robotic hands make these difficult movements with grace and precision. This is particularly important in doing suturing in tight areas where precision is the key to success but it might not be physically possible. The robotic system allows the surgeon the flexibility to create that precision.
In order for Dr. Dean to give this gift to his patients has required of him the sacrifice of time to become facile with the technique and instrumentation. He initially spent one week with Dr. Menon who graciously opened his doors to allow Dr. Dean to see firsthand the technique that he had evolved after 1,500 cases. From this experience he learned the unique laparoscopic instrumentation that facilitated the robotic prostatectomy. He also garnered video footage that he could study to understand the nuances of the procedure. This was a tremendous learning experience for Dr. Dean and he is eternally grateful to Dr. Menon for his graciousness and kindness.
When MultiCare supported the proposal for purchase of the da Vinci robotic system Dr. Dean began to implement his studies at UC Irvine doing nephrectomies and prostatectomy in an animal model and a cadaver respectively. He learned the technical aspects of the machine and its proper setup and positioning so as to maximize its effectiveness. This two-day study set the stage to begin clinical use in men with prostate cancer. But this was not before Dr. Dean spent nearly 200 hours working with the robot at his own hospital practicing with the use of hooking up the components and using the robot in dry lab suturing.
Dr. Dean's ongoing training and continuing education has included extensive travel to attend numerous national meetings to expand his knowledge and skills in robotic surgery and to continue to learn more about national outcomes with respect to radical prostatectomy.
This website is provided for general information purposes only. Consult with your doctor about whether da Vinci ® Prostatectomy may be appropriate for your condidtion. If you have questions about the da Vinci ® Surgical System or the procedure, consult with your doctor.
WILLIAM M. DEAN, M.D.
Specializing in Robotic Prostatectomy
314 Martin Luther King, Jr. Way, Suite 103
Monday: 9-12 & 1-5
Tuesday: 9-12 & 1-5
Thursday: 9-12 & 1-5
Friday: 9-12 & 1-5
(The Office is
closed for lunch
daily from 12-1)