Cutting Edge; Medical progress is measured in many ways. As robotic surgery comes of age, scientists work to exploit the body's immune system. A look ahead.

Byline: Jennifer Barrett

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, 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 a 20- to 25-centimeter 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 five kilometers 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.

Using robots to perform surgery once seemed a futuristic fantasy. Not anymore. An estimated 36,600 robotic procedures will be performed in the United States this year--from heart-bypass surgeries to kidney transplants to hysterectomies. That's up nearly 50 percent from last year, and analysts predict the figure will nearly double in 2006 to more than 70,000 procedures. Since July 2000, about 350 of the da Vinci units have been purchased, including 30 in the last quarter alone, at about $1.3 million apiece. Surgeons who use the system have found that patients have less blood loss and pain, lower risk of complications, and quicker recovery times than those who have open surgery--and even, in many cases, laparoscopic procedures.

The robot has already transformed the field of prostate surgery. This year more than 20 percent of all U.S. prostatectomies will be done with the robot. And that figure is expected to double next year. "It's becoming the standard of care for prostatectomies," says Dr. Santiago Horgan, director of minimally invasive and robotic surgery at the University of Illinois at Chicago.

A 2003 study of 300 patients published in the British Journal of Urology found that those who had prostatectomies lost five times as much blood, had four times the risk of complications and remained in the hospital more than three times as long as those who had robot-assisted ...