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A robot for a male




There are three primary diseases that may affect the prostate gland: benign enlargement, which usually leads to micturition symptoms in elderly men, prostatitis, i.e. an inflammation of the prostate, with or without an infection that may affect young and old men equally, and prostate cancer, which is the most frequent cancer in aging men in most of the industrialized countries. Although all of the above-mentioned diseases are common and affect the prostate, they are not linked to each other. Moreover, benign enlargement and prostatitis are not precursors of subsequent prostate cancer.

Thus, the treatment of these three diseases differs, but only men with localized prostate cancer are candidates for robot-assisted surgery with the Da Vinci System.

Rato T. Strebel, the head physician of the Urology Department of Graubunden Cantonal Hospital knows how a fruitful collaboration develops between a dedicated physician and the perfect precision of a surgical robot.



– Doctor Strebel, cancer of the prostate is the most prevalent type of malignancy in men. What are its features, and who should undergo screening?

– One distinct feature of prostate cancer is that in many cases it develops more slowly than other types of cancer. Therefore, in selected cases continuous observation – we call it active surveillance – without immediate treatment can be offered to patients who have prostate cancer without aggressive features. In response to your second question about the screening: I recommend discussing an examination for prostate cancer with men between 50 and 70 years of age, but only if they present without any other serious medical conditions. Men with a positive family history of prostate cancer should be advised to undergo screening at the age of 45.

– How is the decision made about how to treat patients with prostate cancer?

– Ideally, each patient should be discussed at an interdisciplinary tumor board. At the Graubunden Cantonal Hospital, the tumor board consists of a group of professionals who are involved in diagnosing and treating such patients: urologists, oncologists, radiologists, radiotherapy specialists, pathologists and nuclear medicine specialists. This permits us to study each patient’s case from different standpoints, filter out inappropriate treatments, and select the most effective one. Subsequently, the potential benefits and adverse effects of a specific therapy are discussed with the patient.



– At what point does the Da Vinci robot come into play?

– In men with localized prostate cancer (“localized” means that no signs of metastases are present), surgery, i.e. the surgical removal of the prostate, is the standard treatment recommendation, along with radiotherapy. The Da Vinci robotic system permits us to perform the surgery through 5 or 6 small incisions in the abdominal wall. Since 2009 we have been working with the surgical Da- Vinci S robot, which in April 2015 was replaced with the latest model, the Da Vinci Xi system. Annually, 80 to 100 minimally invasive prostatectomies (removal of the entire prostate gland) are carried out at our hospital. Outcome data are collected in a database so that we can continuously assess our quality and performance.

In addition to prostatectomies, the Da Vinci Xi is used for surgical procedures on the kidneys, bladder and ureters.

– What are the advantages of the new Xi robot from Da Vinci?

– First of all, the new Xi system shares the well- known advantages of Da Vinci robot technology such as high accuracy and the precise motion of instruments in confined spaces, 3D imaging technology, integrated Firefly™ technology and high magnification (10–15x) of the surgical field. The range of motion of the robotic arms and thus of the surgical instruments has increased significantly in the Xi model. In addition, in comparison to the previous models, the handling of the system is easier than with first and second generation models. Furthermore, a high-end Xi simulator system is included, which permits dry-run training.

The main advantages for the patients include faster recovery time and, due to small (8-millimeter) incisions, less risk of significant blood loss, less pain and better cosmetics. However, you can’t rely solely on the equipment and technology to achieve a successful outcome. Of course, these provide support and make our work easier, but at present even the most innovative technology cannot replace an experienced urologist.



Rato Thomas Strebel

Assistant professor and doctor of medicine, head physician of the Urology Department at Graub nden Cantonal Hospital Dr. Strebel graduated from Zurich University in 1995 and obtained his doctorate in 1996. In 2013 he was appointed as an assistant professor at the Medical School of the University of Zurich. He received his training in urology between 1996 and 2002 at Zurich University Hospital, Aarau Cantonal Hospital, and Balgrist University Hospital. In 2003 he became a fellow of the European Board of Urology (FEBU). Between 2003 and 2008 he was a senior physician at the urology department of the University Hospital of Zurich. Since 2008 he has headed the Urology Department of Graub nden Cantonal Hospital.


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