Robotic-Assisted & Other Minimally Invasive Surgical Approaches to Prostate & Kidney Cancer

Intro: MemorialCare Health System, excellence in healthcare, presents Weekly Dose of Wellness. Here's your host, Deborah Howell.

Deborah Howell (Host): Welcome to the show. This is your Weekly Dose of Wellness. I'm Deborah Howell, and today our guest is Dr. Moses Kim. Dr. Kim has been at the forefront of minimally invasive technologies. In 2007, Dr. Kim helped launch the DaVinci Robotics program at the Michael E. DeBakey Veterans Administration Medical Center and performed their first robotic prostate and kidney surgeries. Dr. Kim is affiliated with Saddleback Memorial in Laguna Hills. Welcome, Dr. Kim.

Moses Kim, MD: Great, thanks for having me on the show today.

Deborah Howell (Host): Our pleasure. And our topic today is a big one. It's robotic-assisted and other minimally invasive surgical approaches for prostate cancer and kidney cancer. Wow. I mean, we're really at that day and age. It's pretty incredible.

Moses Kim, MD: Yes, it's really had some great developments in trying to minimize the discomfort for patients and trying to really make these treatments as painless as possible for the patient.

Deborah Howell (Host): So good. Now what types of surgery do you perform at Saddleback Memorial?

Moses Kim, MD: Well, I generally take care of any of the diseases that involve the kidneys, the prostate and the bladder. But I mainly treat cancers of those organs, especially prostate cancer and kidney cancer are the two main cancers that I treat. But I also treat a fair number of patients with bladder cancer. And then there's a smattering of other non-cancer conditions such as benign enlargement of the prostate and kidney stones that I also treat.

Deborah Howell (Host): Great. Okay, well let's start with prostate cancer. What are some of the risk factors and warning signs for men?

Moses Kim, MD: Well, in early prostate cancer there's very, there are no early warning signs. Generally it's detected when on a routine blood test by a primary care provider that checks a PSA, which is a prostate specific antigen. It can also be detected by a digital rectal exam where the prostate is felt and if there are any abnormal nodules, then a biopsy is performed. In later stages of prostate cancer, the patient can start developing more and more difficulties with urination, sometimes pelvic pain. Usually if that's if the prostate cancer has advanced that far, that means it's fairly advanced.

Deborah Howell (Host): Okay, all right. So how often should a man get tested for these?

Moses Kim, MD: Well, a man should get tested on an annual basis with a PSA and a prostate exam by their primary care doctor starting at age 50. If they have a very strong family history, then I recommend starting at an earlier age, at around age 45. And then of course, African Americans are specifically at a high risk of developing prostate cancer, so they should definitely also be screened at an earlier age starting at age 45.

Deborah Howell (Host): Okay. Well you've spelled it out for prostate cancer. Let's do it the same for kidney. For kidney cancer, are there risk factors and warning signs for men and women?

Moses Kim, MD: Yeah, there are there's no specific warning signs of kidney cancer, early kidney cancer. And when they get more advanced, then you can develop some blood in the urine, so if you notice there's blood in your urine, you should definitely go see a urologist right away. Sometimes it can be accompanied with pain down where the kidneys are located, so usually in the lower back area on either side. So those are things to watch out for. Some risk factors for kidney cancer would be if you have a, there are some genetic components, so if anyone in your family has kidney cancer, you should get that looked into. And then of course smoking, which is a really big no-no these days, that can also lead to increased risk of kidney cancer.

Deborah Howell (Host): Right, and of course secondary smoke, so try to avoid those situations if at all possible. What are the treatment options for prostate cancer and kidney cancer?

Moses Kim, MD: Well, the one for prostate cancer is fairly complicated, but in a nutshell there are two options, treatment-wise in the United States. One is surgical, where we use the robot to go ahead and remove the entire prostate. And then the other option would be radiation treatment for the treatment of prostate cancer. If you have a slow-growing type of prostate cancer, then what's become more popular nowadays is a surveillance protocol where you put a patient on a very rigorous surveillance protocol and we just watch it. And if the cancer does not progress to a faster-growing type, then we just end up watching it forever and not treating it.

Deborah Howell (Host): And that's especially true in older men, correct?

Moses Kim, MD: That's definitely true in older men, yes.

Deborah Howell (Host): Okay. Tell us a little bit more about robotic-assisted and other minimally invasive surgical approaches.

Moses Kim, MD: Well for prostate cancer, we use a robot nowadays. I would say probably about 90% of all prostate cancer surgeries in the United States is done with a robot. And the surgery is done through five small incisions placed throughout the abdomen instead of one large incision. So of course there's less pain and shorter recovery time with these smaller incisions. There's much better visibility. The robot instruments are inserted through these little incisions and we also put a three-dimensional camera in through one of the incisions so that you can get a 3D view and it magnifies up to 10 times, so you can get a really good view of what you're working on. And it's almost like the equivalent is having my hand inside the patient's body but through tiny incisions. So you can pretty much do anything that you can surgically with your hands that you can do with a robot. The main-

Deborah Howell (Host): So to be, I was just going to say, to be clear, when we say robotic surgery, people listening, maybe have not been exposed to this type of information. It's not a robot operating on you. It's a robot manipulated by a human surgeon with a high degree of experience.

Moses Kim, MD: That is exactly correct. I control every movement of the robot. When I move my right hand in a certain direction, the instrument that is coordinated with my right hand moves. And so with my left hand, if I twist my wrist in a certain direction, the instrument moves in that exact motion that I move my hand. So it responds very well to every motion in my hands. And that's how I control the robot. The robot is not pre-programmed to do the surgery, it's controlled specifically by the surgeon.

Deborah Howell (Host): So think of it as a scalpel, it's just a different type of tool.

Moses Kim, MD: It's a very different type of tool. Yes, exactly. And because of the better visibility, you have much less blood loss from the surgery and a much quicker recovery for it because of that. And for instance, if we're gonna go back to the kidney cancer treatment. I would say probably about 10 to 15 years ago, all types of kidney cancer surgeries, especially for small kidney tumors were done through a very large open incision. And that's a recovery of about six weeks, five days hospital stay, lots of pain. And now you can convert that into a surgery through five or six small incisions, a two-day hospital stay, back to full speed in three weeks. Very little blood loss, transfusion rates are extremely low. So it's really changed the treatment of kidney cancer.

Deborah Howell (Host): And if they needed additional therapy after the surgery, you could get right to it as opposed to waiting for so long for the healing process.

Moses Kim, MD: That's exactly correct. So that you can really get them to the next phase of treatment if they need it fairly quickly.

Deborah Howell (Host): Wow. That's just such a good day for patients who are suffering from these conditions. We spoke about the advantages, are there any other advantages maybe that we haven't thought of?

Moses Kim, MD: Well, the because the incisions are all small, the patients have a lot less scarring and some of the newer technology coming down the road for robotic surgery is that you can try, you can do some of the surgery, some of the simpler surgeries through a very tiny pinhole incision, one single incision around the belly button. So when that heals up, it's almost completely scarless. So in the right patient and when the right type of procedure, you can definitely do what I call a scarless surgery. And so I, you know I've definitely had patients opt for that and have an amazing outcome.

Deborah Howell (Host): Wow. I have one question. I know it's a little off topic, but I am really quite interested in the kidney stone robotic surgery. What do you do?

Moses Kim, MD: Depends on the, you first of all you have to pick the right patient, but if the stone is located in a certain area, what you can do is you go in with the robot through a bunch of little incisions and you can literally cut open the kidney and just scoop out the stone. And then sew the kidney back up. So the recovery is fairly quick with that kind of a procedure. Just small little incisions that you recover from, just probably an overnight hospital stay. Probably back to full speed in two to three weeks. That is not a commonly used method for removing kidney stones, but I have to say that I have done a fair number of those at Saddleback Hospital of removing kidney stones with the robot.

Deborah Howell (Host): Because as we all know the pain can be just excruciating with those kidney stones.

Moses Kim, MD: Yes, that's correct.

Deborah Howell (Host): So, well, so lovely that there are so many more new options available to us. I do have one last question. How do you determine if the robotic-assisted approach is appropriate for each patient?

Moses Kim, MD: Well, generally, I've met maybe one patient in my entire practice who I thought the robot was not appropriate for. So basically it means that it's appropriate for just about anybody. Regardless of the patient's age, size, even if they've had extensive previous abdominal surgeries with extensive scarring, you can still do the robotic surgery on them. So, I, you know, there's very few patients that I've met where I would say that they would not be a good candidate for robotic surgery.

Deborah Howell (Host): And the improvements just keep coming every day, so I hope to have you back in a few months and maybe more developments might have happened by then.

Moses Kim, MD: Great. Thank you for having me on the show today.

Deborah Howell (Host): Our total pleasure, Dr. Kim. To learn more or to listen to a podcast of this show, please visit memorialcare.org. I'm Deborah Howell. Join us again next time as we explore another Weekly Dose of Wellness and have yourself a fantastic day.