Doctor Scott

During the past seven years, John Scott ('82 MD), a urologist in Carmel, Ind., and his colleagues, have led the way in robotic-assisted prostatectomy (RAP) surgery. Using a $1.5 million robotic device, called the da Vinci® Surgical System, Scott seated a few feet away from the patient uses an image of the surgical field to guide the robot through the surgery. This minimally invasive technique requires just five punctures rather than an incision, making it the least painful method for patients and it can potentially provide a better outcome.

As laparoscopy was evolving as a preferred choice for a few urologic surgeries in the 1990s, Scott was working as a clinical assistant professor at Methodist Hospital (now part of Clarian Health) in Indianapolis. During that time, Methodist's heart surgeons acquired the first robot in the state to perform heart surgery. And whether fate or fortune for Scott, the equipment became available for other surgeries. Scott, and a colleague, spent two months learning to use the robot. He performed his first robotic-assisted prostatectomy in 2003.

'The most significant aspect of this surgery is the benefit to the patient. The recovery time is significantly reduced as compared to a surgery using an incision,' said Scott. 'Punctures hurt less than cuts. We have patients that are back to work within a week.

'A prostatectomy is performed on patients with cancer of the prostate. They may be undergoing additional treatment depending on the severity of their disease. The hope is that the surgery is the cure,' said Scott.

Scott is a physician with Urology of Indiana, a group composed of 30 urologists and two urogynecologists. The surgery is conducted in teams; there are four teams in the practice. They perform 10 to 12 prostatectomies a week. Scott has been involved in more than 1,200 surgeries since he began using the technique five years ago.

The technique does present some challenges. It takes some time for a physician to get comfortable with the device. And because it's equipment driven, there are advances in technology requiring a physician to continually stay up-to-date on the system. In addition, the device itself is costly, $1.5 million, and requires about $100,000 in maintenance per year. To be cost effective, a practice must perform a significant number of surgeries each year to maintain and pay for the system. With the introduction of RAP, surgeries performed by incision have dropped. Five years ago, 95 percent of surgeries used an incision. In 2006, just 50 percent of surgeries were performed in this way.

Because Scott has had a lot of experience performing RAP, he often attracts clients whom other physicians are reluctant to work on because they have extenuating circumstances. 'Some of my clients are obese or have had previous surgeries,' says Scott. 'I've created a niche for myself which is fine because it gives more patients an opportunity. The ultimate challenge for me is providing better oncologic and functional outcomes for the patient.'

Scott's expertise has brought patients from as far as Alaska and Venezuela. He also has trained approximately 50 physicians in the technique, including a team from Australia. In his experience, the easiest physicians to train are those who have performed many prostatectomies, have experience in laparoscopic surgery and are familiar with the anatomy. 'Sometimes, training can be challenging, because if you've done this surgery in one way your whole career and it's been successful, you may wonder why you need to change,' said Scott. 'Although this technique can be more precise and is completely controlled by the physician, some are resistant to the idea of converting to laparoscopic surgery since open surgery has worked well for them.'

After practicing for 20 years, Scott who almost chose orthopaedics as his specialty is glad that he stayed with urology. 'It's been a great experience. I couldn't ask for a better career,' said Scott. 'I feel grateful to the staff and physicians at Iowa who made medical school a great experience for me. I grew up in Iowa and had applied to other schools, but I knew that I wouldn't get a better education than at the UI. My education has been the foundation for my success.' Scott and his wife, Tracie, have three children and reside in Carmel, Ind.