Tuesday, April 04, 2006

Cutting Edge

Medical progress is measured in many ways. As robotic surgery comes of age, Katrina's victims struggle to find the most basic care. A look ahead.
By Jennifer Barrett
Updated: 2:57 p.m. ET Dec. 4, 2005
Dec. 12, 2005 issue - Stuart Forbes celebrated his 60th birthday on April 11. A week later, he was diagnosed with prostate cancer. "It was quite a month," says Forbes, a blunt Vietnam veteran who runs a consulting firm outside Boston. When biopsies confirmed he had an aggressive form of the disease, Forbes started looking for a surgeon. The first recommended a traditional radical prostatectomy, which would require an eight- to 10-inch incision and at least two days in the hospital. Forbes was also warned that he would likely lose almost all the nerves on the left side of the prostate, which could permanently affect his sexual function. "I thought, 'I need to really look at all my options'," says Forbes. He considered high-intensity focused ultrasound ablation, a relatively new technology that's been used in Europe. But it's expensive and would require transatlantic trips. He looked into various forms of radiation, as well as proton-beam therapy. Then, in June, his girlfriend took him to a symposium on robotic surgery. "I saw the machine and how it worked," remembers Forbes. "It was just incredible. I said, 'That's it'."

In August, Dr. Ashutosh Tewari, director of robotic prostatectomy at NewYork-Presbyterian Hospital/Weill Cornell, removed Forbes's walnut-size prostate and lymph nodes and reattached his bladder to his urethra without once putting his hands inside the patient. Using Intuitive Surgical's da Vinci robotic system and operating through five tiny incisions, Tewari conducted the entire procedure from across the room. He sat at a console and turned two knobs to remotely manipulate tiny surgical instruments attached to adjustable robotic arms. Forbes was walking within hours of his surgery and was discharged the next day. He compares the discomfort from the largest incision (about two inches long, and the only one to require stitches) to a bad pimple. By midweek he was walking three miles daily. In 10 days he was back at work. After three weeks he was playing golf again; by late October he'd regained normal urinary, and most sexual, function. "I'm about as excited as anyone can be about this procedure," he says.
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