City of Hope urologic surgeons recently completed the world’s first dual robotic operation using the da Vinci Si HD Surgical System.

The da Vinci Si allows two surgeons to operate remotely on a patient at the same time from two separate consoles. Intuitive Surgical chose City of Hope as one of only four institutions in the world to pilot the new system, which allows experienced surgeons to safely instruct fellows in the latest robotic, minimally invasive techniques.

Clayton Lau, rear, and Jason Jankowski remove prostate tissue remotely through twin da Vinci consoles. (Photo by Alicia Di Rado)

Urologic surgeon Clayton Lau, M.D., clinical assistant professor of surgery, led the robotic prostatectomy in mid-April. Urologic surgery fellows Ciamack Kamdar, M.D., and Jason Jankowski, M.D., worked alongside Lau to remove a patient’s cancerous prostate gland, as well as nearby lymph nodes.

As the procedure began, Lau and Jankowski each sat at a da Vinci console, side by side, about five feet away from the patient, while Kamdar stood at the patient’s bedside. Each console features a high-definition screen showing the surgical field magnified up to 14 times its actual size, as well as a touch screen and highly sensitive hand controls. Microphones and speakers allow the surgeons to communicate and listen to discussion in the operating room without moving away from the console.

As the lead surgeon, Lau demonstrated techniques for removing the prostate from surrounding tissue. He could give the surgical fellows control over surgical instruments — or turn off their access to the instruments — at any time. As the surgeons pinched their fingers in the controls, the surgical robot’s arms moved in sync.

“We have the ability to completely take control, then take it back,” explained Lau, as he watched Jankowski carve the prostate gland away from the bladder. “Ok, you’ve got it,” he told the fellow.

Halfway through the procedure, Kamdar and Jankowski switched places. Each surgeon can sign in at the surgical console, which readjusts itself automatically to each surgeon’s preferred height and body positioning.

“Slow down, take your time,” Lau reminded Kamdar, as the fellow maneuvered tiny scissors and carefully avoided damaging bundles of nerves around the prostate.

The system also features a more compact surgical robot that can be more easily adjusted at the patient’s bedside. Lau already noticed that the improvements have cut the time needed to set up the robot before surgery. The system also allows surgeons to record procedures, so they may review technique on cases afterward.

“This system helps me teach fellows efficiently,” Lau said. “And it allows fellows to handle more of a case, under supervision.”

Lau believes the new dual system will make City of Hope’s urologic surgery fellowship program, which emphasizes robotic minimally invasive techniques, even more competitive. The one-year program accepts three fellows each year.

“We enjoy training excellent surgeons,” Lau said. “This system makes it easier for us to do that.”