CINJ urologic oncology chief completes 1,000th robotic prostatectomy at RWJUH

Marking a major milestone in what has become a fast-growing standard of care in prostate cancer surgery, the chief of urologic oncology at The Cancer Institute of New Jersey has completed his 1,000th robotic prostatectomy at Robert Wood Johnson University Hospital (RWJUH), the Flagship Hospital of The Cancer Institute of New Jersey, which is a Center of Excellence of the University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School (RWJMS).

Isaac Kim, MD, PhD, associate professor of surgery at RWJMS, performed the operation recently on a Newark man diagnosed with high-risk localized prostate cancer. Robotic prostatectomy allows a surgeon to control a set of robotic arms that hold tiny surgical instruments used to remove the patient's cancer. Unlike the traditional open method of prostate surgery that results in a six-inch scar in the abdominal area, patients who undergo this minimally-invasive surgical technique are left with incisions smaller than a dime. In the U.S., robotic prostatectomy is being performed on 85 percent of men who have their prostate removed (Journal of Clinical Oncology - doi: 10.1200/JCO.2011.36.862). This compares to only 10 percent of men a decade ago after the procedure first received FDA approval and started to be widely used.

Along with a minimally-invasive approach, the procedure allows for additional precision with a 3-D view of the tissue and delicate nerves that envelop the prostate. Reduced blood loss, shorter hospital stays and a faster time to achieve full continence are also hallmarks of the procedure. "During the seven year period during which I performed my 1,000 procedures, the blood transfusion rate was only 0.3 percent and the duration of the hospital stay was only one day in 95 percent of the patients. Simultaneously, rate of recovery of urinary continence and sexual function remain high," noted Dr. Kim, who is also the executive director of the Dean and Betty Gallo Prostate Cancer Center at The Cancer Institute of New Jersey.

Recent patient Sidney Travis had his cancer detected through a prostate exam during a regular check-up with his physician this past spring. He had just turned 50, and his girlfriend - a registered nurse - encouraged him to have it done.

"I don't think getting screened is at the top of anyone's 'to-do' list, but being African American and having a father and two uncles who battled prostate cancer, I knew it was time to be more proactive about my health," he said. A former history teacher, Travis has spent numerous summers in recent years walking six miles a day as a golf caddy. He is currently busy starting his own solar consultation company and still takes time daily to keep up a walking regimen. "It's a period in my life where I don't want anything to slow me down," he noted, especially a longer recovery that the traditional open prostatectomy method usually holds. "I was presented with other treatment options at another facility, but I felt that it was important to explore the benefits available to me before making an immediate decision. Given my age and my active lifestyle, and after I learned more from Dr. Kim, the robotic procedure seemed to be the right fit."

While the robotic technology allows a surgeon more advantages, Kim is quick to point out that it is having a surgeon who is well trained and experienced in the technology that helps account for positive outcomes. "Those in the field consider 250 procedures as a benchmark where one can start to achieve positive outcomes on a consistent basis. And we at The Cancer Institute of New Jersey and RWJUH are proud to be driving the next generation of innovative robotic surgical techniques, by offering specialized training to our surgeons," he noted. RWJUH is one of the few hospitals in the state designated to teach other surgeons how to use the robotic system for the procedure.

Kim's achievement includes surgeries completed with the Athermal Intrafascial Robotic (AIR) technique, which he developed. In the AIR procedure, the nerve that controls a man's ability to have an erection is better preserved by sparing over 90 percent of the tissue that surrounds the prostate as compared to 40 to 50 percent in the conventional open or robotic radical prostatectomy. Kim says that employing the AIR technique allows patients to regain sexual function and bladder control in a quicker fashion.

Along with the 1,000 robotic prostatectomies, Kim has also performed approximately 100 robotic kidney procedures.