By Danielle Dellorto, ATLANTA, Georgia (CNN) — As 3D images illuminate the viewfinder, a joystick delicately maneuvers a pair of robotic arms. It may sound like a video game, but Dr. Nikhil Shah is actually performing cancer surgery.

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Robotic surgery allows for smaller incisions, reduced blood loss and much greater precision by the surgeon.

Precision that far exceeds the human hand

In this case, the surgeon is removing a man’s prostate gland. Roboticsurgery is a growing trend in treating prostate cancer. The number of cases have increased sevenfold in the past four years, from 10,000 in 2004 to a projected 70,000 in 2008, according to Intuitive Surgical Inc., the creators of the robotic device. The advantages of robotics — fewer side effects and quicker recovery times in many patients — have led to increased use for other surgeries, including hysterectomy, kidney cancer and some heart procedures.

“At first, men think we hook up a robot and then go get some coffee, but the reality is the robot arms are a tool that I control, just like a scalpel, ” said Shah, who has performed more than 600 robotic prostatectomies at St. Joseph Hospital in Atlanta, Georgia.

One benefit Shah describes is precision that far exceeds the human hand. The robot-controlled scalpel works delicately around the nerves and blood vessels in the pelvic area, vastly reducing the risk of damage that can lead to incontinence or impotence. “I’m able to spare all the things that help men have their dignity and at the same time take away the cancer,” he said.

Studies have shown some benefits of robotically performed prostatectomy over a traditional open prostatectomy — but the data aren’t overwhelming. One clear advantage, Shah said, is the reduced blood loss. Also, robotic surgeries are considered minimally invasive. Instead of a 4½-inch incision, robotics patients have six dime-sized incisions in the abdomen. Some patients experience only minimal pain and are in the hospital less than 24 hours.

But experts at the American Urological Association aren’t yet describing the procedure as the new gold standard of care. “The outcomes of robotic operations have been excellent,” said AUA spokesperson Dr. J. Brantley Thrasher, chairman of urology at University of Kansas Medical Center. “But to say we’ve seen a quantum leap in regards of one treatment being better than the other is premature.”

Thrasher acknowledged that robotic prostate surgery is the fastest growing surgical procedure, a trend that will increase. “What’s driving the increase is truly the consumer. Patients are requesting it like never before,” he said. “The fact that less blood is lost and a short hospital stay is appealing for some patients.”

Tony Pouncey, 60, is one of those patients. His prostate cancer was diagnosed earlier this year. “I freaked out a bit, got on the Internet, and called around to find out what was out there for me,” he said. For Pouncey, the size of the incision was the deciding factor. “I do a lot of exercise. I wanted to be back on my feet as quick as possible.” He had a robotic prostatectomy last month and is now cancer free.

“I feel great,” he said. “I was amazed at what little pain I had. I was at home and even walked my dog the very next day.”

Shah said Pouncey’s experience is more the norm than the exception, but points out not everyone qualifies for robotic surgery. Patients with excess abdominal fat and those with cancer that is not localized would not be ideal candidates. “It’s important to talk to your doctor to figure out what is the best way to treat your individual case,” Shah said.

The surgery can cost up to $15,000. It’s also not always covered by insurance. Medicare leaves it up to regional offices to determine coverage case by case.

According to the American Cancer Society, one in six men will develop prostate cancer in their lifetime. “Most important thing is for men to get screened and know what treatment options are out there for them,” Shah said.

Current recommendations say men should get annual prostate screenings starting at age 50. For African-Americans and other high-risk men — for example, men with a first-generation family history of the disease — testing can begin as early as age 40.

On Monday, the U.S. Preventive Services Task Force committee updated its screening guidelines and now recommends against routine prostate cancer screening for men over the age of 75. The committee believes if diagnosed after age 75, the cancer is unlikely to affect the men during their lifetime.

The prospect of cancer surgery may make you feel anxious. Put your mind at ease by learning more about cancer surgery and how and why it’s used.

The Mayo Clinic – Cancer surgery — an operation to repair or remove part of your body to diagnose or treat cancer — remains the foundation of cancer treatment. Your doctor may use cancer surgery to achieve any number of goals, from diagnosing your cancer to treating it to relieving the symptoms it causes. Cancer surgery may be your only treatment, or it may be supplemented with other treatments, such as radiation, chemotherapy, hormone therapy and biological therapy.

How is cancer surgery used in treatment?

Cancer surgery may be used to achieve one or more goals. Common reasons you might undergo cancer surgery include:

* Cancer prevention. If there’s reason to believe that you’ll develop cancer in certain tissues or organs, your doctor may recommend removing those tissues or organs before cancer develops. For example, if you have a genetic condition called familial polyposis, your doctor may use cancer surgery to remove your colon and rectum because you have a high risk of developing colon cancer.
* Diagnosis. Your doctor may use a form of cancer surgery to remove (biopsy) all or part of a tumor — allowing the tumor to be studied under a microscope — to determine whether the growth is cancerous (malignant) or noncancerous (benign).
* Staging. Cancer surgery helps your doctor define how advanced your cancer is, called its stage. Surgery allows your doctor to evaluate the size of your tumor and determine whether it’s traveled to your lymph nodes. Additional tests might be necessary to gauge your cancer’s stage.
* Primary treatment. For many tumors, cancer surgery is the best chance for a cure, especially if the cancer is localized and hasn’t spread. If there’s evidence that your cancer hasn’t spread, your doctor may recommend surgery to remove the cancerous tumor as your primary treatment.
* Debulking. When it’s not possible to remove all of a cancerous tumor — for example, because doing so may severely harm an organ — your doctor may remove as much as possible (debulking) in order to make chemotherapy or radiation more effective.
* Relieving symptoms or side effects. Sometimes surgery is used to improve your quality of life rather than to treat the cancer itself — for example, to relieve pain caused by a tumor that’s pressing on a nerve or bone or to remove a tumor that’s obstructing your intestine.

Surgery is often combined with other cancer treatments, such as chemotherapy and radiation. Whether you opt for additional cancer treatment depends on your cancer and its stage.

How is cancer surgery traditionally performed?

Traditionally, the primary purpose of cancer surgery is to cure your cancer by physically removing all of it from your body. The surgeon usually does this by cutting into your body and removing the cancer along with some surrounding tissue to ensure that all of the cancer is removed. Your surgeon may also remove some lymph nodes in the area to determine if the cancer has spread. This helps your doctor assess the chance of your being cured, as well as the need for any further treatment.

In the case of breast cancer surgery, your doctor may remove the cancer by removing the whole breast (mastectomy) or by removing only the portion of your breast that contains the cancer and some of the surrounding tissue (lumpectomy). In the case of lung cancer surgery, your doctor may remove part of one lung (lobectomy) or the entire lung (pneumonectomy) in an attempt to ensure that all the cancer has been removed.

What other techniques are used in cancer surgery?

Many other types of surgical methods for treating cancer and precancerous conditions exist, and investigators are always researching new methods. Some common types of cancer surgery include:

* Cryosurgery. During this type of surgery, your doctor uses very cold material, such as liquid nitrogen spray or a cold probe, to freeze and destroy cancer cells or cells that may become cancerous, such as irregular cells in a woman’s cervix that could become cervical cancer.
* Electrosurgery. By applying high-frequency electrical currents, your doctor can kill cancer cells, for example, in your mouth or on your skin.
* Laser surgery. Laser surgery, used to treat many types of cancer, uses beams of high-intensity light to shrink or vaporize cancer cells. In some cases, the heat of the laser accomplishes this. In other cases, the laser is used to activate a previously administered chemical that cancer cells absorb. When stimulated by light, the chemical kills the cancer cells.
* Mohs’ surgery. Useful for removing cancer from sensitive areas of the skin, such as near the eye, and for assessing how deep a cancer goes, this method of surgery involves carefully removing cancer layer by layer with a scalpel. After removing a layer, your doctor evaluates it under a microscope, continuing in this manner until all the abnormal cells have been removed and the surrounding tissue shows no evidence of cancer.
* Laparoscopic surgery. A surgeon uses a laparoscope to see inside your body without making large incisions. Instead, several small incisions are made and a tiny camera and surgical tools are inserted into your body. The surgeon watches a monitor that projects what the camera sees inside your body. The smaller incisions mean faster recovery and a reduced risk of complications. Laparoscopic surgery is used in cancer diagnosis, staging, treatment and symptom relief.
* Image-guided surgery. In some instances, surgeons can rely on real-time images of your body to guide them when operating. For instance, rather than opening your skull to physically see inside your brain, a surgeon may use magnetic resonance imaging (MRI) to visualize the brain and allow for a much smaller opening to carry out the operation. MRI images allow the surgeon to be very precise, removing the tumor while minimizing damage to surrounding tissues. Many other cancers can be treated using image-guided surgery. Other imaging techniques are used as well, including computerized tomography (CT) and ultrasound.
* Robotic surgery. In robotic surgery, the surgeon sits away from the operating table and watches a screen that projects a 3-D image of the area being operated on. The surgeon uses hand controls that tell a robot how to maneuver surgical tools to perform the operation. Robotic surgery helps the surgeon operate in hard-to-reach areas. But robotic surgical systems are expensive and require specialized training, so robotic surgery is available only in specialized medical centers.

Cancer surgery continues to evolve. Researchers are investigating other surgical techniques with a goal of less invasive procedures.

What can you expect before and after cancer surgery?

Preparation and healing from cancer surgery varies greatly based on the operation you’re undergoing. But in general, you can expect certain similarities, including:

* Preparation. In general, expect to undergo certain tests, such as blood tests, urine tests, X-rays and other imaging tests, in the days preceding your surgery. These tests will help your doctor assess your surgical needs, such as your blood type should you need a transfusion, and identify potential risks, such as infections, that may influence your surgery.
* Anesthesia. If you’re having surgery, you’ll likely need some type of anesthetic — a medication that blocks the perception of pain. Your options for anesthesia will be based on what type of surgery you’re receiving.
* Recovery. Depending on your surgery, you may stay in the hospital for a time before going home. Your health care team will give you specific directions for your recovery, such as how to care for any wounds, what foods or activities to avoid and what medications to take.

What are the risks of cancer surgery?

As with any surgery, cancer surgery does carry risks. What side effects you might experience after cancer surgery will depend on your specific surgery. In general, most cancer operations carry a risk of:

* Pain. Pain is a common side effect of most operations. Some cause more pain than others do. Your health care team will tell you how to keep your pain to a minimum and will provide medications to reduce or eliminate the pain.
* Infection. The site of your surgery can become infected. Your health care team will show you how to care for your wound after surgery. Follow this routine closely to avoid infection, which can lengthen your recovery time after surgery. Doctors treat infections most often with antibiotics.
* Loss of organ function. In order to remove your cancer, the surgeon may need to remove an entire organ. For example, your kidney may need to be removed (nephrectomy) if you have kidney cancer. For some such operations, the remaining organ can function sufficiently to compensate for the loss, but in other situations you may be left with impairments. For instance, removal of a lung (pneumonectomy) may cause difficulty breathing.
* Bleeding. All operations carry a risk of bleeding. Your surgeon will try to minimize this risk.
* Blood clots. While you’re recovering from surgery, you’re at an increased risk of developing a blood clot. Though the risk is small, this complication can be serious. Blood clots most commonly occur in the legs and may cause some swelling and pain. A blood clot that breaks off and travels to the lung could cause a pulmonary embolism, a dangerous and sometimes deadly condition. Your surgeon will take precautions to prevent blood clots from developing, such as getting you up and out of bed as soon as possible after your operation.
* Altered bowel and bladder function. Immediately after your surgery you may experience difficulty having a bowel movement or emptying your bladder. This typically resolves in a few days, depending on your specific operation.

Whatever cancer treatment your doctor recommends, you’re likely to feel some anxiety about your condition and the treatment process. Knowing what to expect can help. Use this information to help you talk with your doctor and ask informed questions.

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