Celebrating the 25th Anniversary of the first Robotic Prostatectomies
in the US in 2000, and why it all started in the City of Detroit
26 November 2025
Introduction
This year marks the 25th Anniversary of approval by the FDA for the initial use of the da Vinci system. Historically, minimally invasive surgery in the form of laparoscopy was adopted by Gynecology in the 1980’s and general surgery in the 1990’s. But urologic procedures were considered too challenging for a laparoscopic approach by most surgeons, and the open procedure was the gold standard. Intuitive Surgical in California had acquired technology from other innovative companies and developed the first commercial robotic surgery platform, the da Vinci Robot. Working with the Defense Department initially, the robot was focused on cardiovascular applications which would support battlefield surgeons. But the first commercial applications that created real reaction actually occurred in the field of urology. It is fitting at this time to look at how this occurred.
The Pioneers and Visionaries
Like all good stories, there are a number of key players that deserve an introduction to help understand how this all came together.
Dr. Mani Menon: Dr. Menon is a Surgeon who trained in India and originally wanted to focus on Neurology, but after moving to the US, turned to Urology at John Hopkins and trained under Pat Walsh. Focusing initially on kidneys and spending time in WashU and UMass, he eventually ended up at Henry Ford Hospital in Detroit in his late forties, having done by that stage over 1,000 open prostatectomies. Dr Menon was and is an academic surgeon who always believed in tracking and following the data.
Raj and Padma Vattikuti. Raj Vattikuti and his family moved to the US in 1977 specifically to the Detroit area and successfully built several businesses in the IT arena. Because of their success, they decided to set up the Vattikuti Foundation in 1997 initially to give back to Southeast Michigan and specifically look at healthcare and help combat cancer. They focused on breast and prostate cancer, which were the two most prevalent cancers at the time.
Intuitive Surgical. At the time, Intuitive Surgical was a small venture backed surgical robotics company that was trying to break into the cardiac surgical space. At this time, they had sold 17 systems worldwide, all of them into cardiac centers, the majority of these being in Europe. Lonnie Smith had just been appointed CEO, and Gary Guthart and Dave Rosa were key members of the engineering teams.
Henry Ford Hospital. This would include Menon’s team of Dr. Ash Tewari, Dr. James Peabody, and the nursing staff as well as the management team who would have had to support the venture.
French Laparoscopic surgeons. Specifically, Bertrand Guillonneau and Guy Vallencien from the Montsouris Institute who at the time were leading minimally invasive urologic surgeons.
The City of Detroit. Detroit at the time has a population of just under 1 million people, dominated by the motor industry with 80% of the population African American. It is known that African American men have a higher incidence of prostate cancer than the general population.
The Problem
At the end of the 1990’s there were only two possible ways to treat prostate cancer. Option one was through an open prostatectomy, and the second would have been through some form of radiation treatment. When Dr. Menon arrived in Detroit, he studied data on the area and noticed that while African Americans had a higher prevalence of prostate cancer, they were more likely to choose radiation as a treatment option and that their long-term survival rate was not as good as those who had received an open radical prostatectomy. He believed that there was a cultural phenomenon in the African population that made them more resistant to open surgery. He therefore decided that he should learn a less invasive way of doing a radical prostatectomy. He tried laparoscopy but felt he could not master it.
The Solution
Around the same time Raj and Padma Vattikuti were setting up the Vattikuti Foundation and looking for a project to fund. Dr. Menon and the Vattikuti’s met; and the Vattikuti Urology Institute at the Henry Ford Hospital was formed and funded to the tune of $20M. A peculiarity of this funding was that it was not an endowment to be spent over years, and it was not overseen by a committee. Dr. Menon was given the responsibility of driving the investment to gain maximum results. The decision was made to invest in a da VinciÔ robotic platform as Dr. Menon thought that this would facilitate the execution of a less invasive approach to radical prostatectomies. One of the challenging issues Dr. Menon encountered in trying to master the laparoscopic approach was the difference in body mass and size between patients in the US and those in Europe. He surmised, correctly, that robotic surgery would overcome the issues of obesity that limited the use of laparoscopic surgery in these patients.
Dr. Menon and his team traveled to Sunnyvale, California to discuss with Lonnie Smith and the Intuitive team the purchase of a da VinciÔ for use in Urology. He was told clearly that Intuitive was a cardiac company and would not necessarily be able to support him directly. Undeterred, the decision to purchase the $999,000 system was made.
The Process
This is where I believe the magic happened. You do not just need a good idea; you need to execute it well.
At that time, the Montsouris Institute in Paris was considered one of the leading minimally invasive urological centers in the world. Dr. Menon and his team decided to learn from these surgeons and adapt their technique to the da VinciÔ. Thanks to the funding provided by the Foundation, a plan was put in place that two French surgeons would fly over for a week once a month to Detroit for a year and carry out three to four laparoscopic prostatectomy surgeries. The same week, three to four robotic surgeries would be performed. Every surgery would be recorded and all relevant data reviewed. Every evening, videos were critiqued to assess technique and discuss potential improvements.
All patients were given the option of either an open surgery from an experienced surgeon or a new “robotic” approach. Dr. Menon had expected a 10% acceptance rate but was surprised that in fact over 70% accepted initially. He surmised that as the Detroit patients were used to seeing robots in action in their workplace and understood the benefits of precision they brought, it made sense for them to also be used in another environment.
The Result
At the end of the 12-month period, 48 laparoscopic procedures had been carried out against 50 robotic cases. 1. The populations were comparable, and all measured parameters were comparable to the “best-in-class” values for laparoscopic radical prostatectomy reported in the literature. It has not been an easy journey. The first case had to be converted to open, and at that point, Dr. Menon nearly stopped the program due to some leg paralysis the patient was experiencing. Fortunately, this rectified itself. At the fifth case, the time was faster than the laparoscopic equivalent, but this was seen as a fluke. However, by the 18th case, this became the norm.
The other essential element was that in others’ studies, the Henry Ford team showed that there were significant improvements for the patients in this approach versus an open procedure.3 Blood loss wea significantly less and transfusions went from 69% to 0%. There were four times as many complications with the open approach; hospital stays were reduced. Cancer control was equivalent or slightly superior and quality of life measures, such as return to continence and potency were better.4
By the end of 2003, over 1000 cases were done at Henry Ford.
By the end of 2004, it was estimated that 7,000 prostatectomies were done in the US, about 10% of the market.
In 2023, a 15-year survival paper was published which included some of the men from these early cohorts, Showing the continued commitment for rigorous science. 4
The Impact
Without the strong scientific rigor defined by Dr. Menon at the outset, the program would not have been successful. Dr. Menon and his team published several papers explaining the technique and comparing it to open and laparoscopic prostatectomy. The reaction was not positive, and a number of centers in California and elsewhere tried to prove them wrong. They did not succeed.
In addition, Under Lonnie Smith the leadership at Intuitive was able to see what was happening; not many cardiac programs would have been doing 50 procedures in their first year. They decided to pivot and change course and put the bulk of their resources into urology. It also helped that they understood the importance of clinical engineering to support the clinician and ensure that they focused on a procedure that was repeatable, teachable, and had a demand.
Despite pushback from naysayers who thought that robotics was too expensive and even dangerous, patients started to move towards centers that were offering a this less invasive.
Intuitive management was influenced by Geoffrey Moore’s book “Crossing the Chasm” and focused resources on moving the market from 10% penetration to over 20%. Drive the beachhead procedure and the rest will follow. They did this successfully.
The Vattikuti Foundation continued to support procedural development at Henry Ford through the Vattikuti Urology Institute in areas such as kidney and bladder cancer. Eventually in 2010, Raj Vattikuti set up the Vattikuti Technologies company to help bring robotic surgery to India.
Conclusion
For me, there are a number of lessons that can be learned and are still relevant today for innovation in this space.
There needs to be a real clinical need. The innovation must move the dial meaningfully for patients but also for surgeons/physicians and health care providers.
Ensure scientific rigor. Plan to publish your work to expose it to peer scrutiny. Not just the one off but meaningful numbers.
Have an entrepreneurial spirit. Do not be afraid of failure as long as this does not involve patients.
There needs to be full support from the site of delivery, in this case the hospital
The company itself must listen to its customers and be willing to adapt and change, Intuitive pivoted from Cardiac to Urology, which would not have been easy.
Understanding how the product can be used safely, efficiently, and repeatably is key. This was achieved through the concept of clinical engineering.
Once the idea is solid and validated impart the knowledge through papers, congresses, and training programs
There is always an element of luck being in the right place at the right time.
Acknowledgements
I would like to thank the back table urology podcast from Dr. Aditya Bagrodia from UC San Diego with Dr. Mani Menon, which gave some color on the beginnings of Robotic prostatectomies in the US and the impetus to write this article. Dr. John Lenihan with proofreading and editing support.
References
1 Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience
Authors Mani Menon, Ashutosh Tewari, Brad Baize, Bertrand Guillonneau, Guy Vallancien
Urology November 2002
2 Vattikuti Institute prostatectomy: technique
Authors Mani Menon, Ashutosh Tewari, James Peabody, VIP TEAM*
The Journal of Urology June 2003
3 A prospective comparison of radicastudies l retropubic and robot‐assisted prostatectomy: experience in one institution
Authors A Tewari, A Srivasatava, M Menon, VIP team
BJU international August 2003
4 Laparoscopic and robot assisted radical prostatectomy: establishment of a structured program and preliminary analysis of outcomes
Authors Mani Menon, Alok Shrivastava, Ashutosh Tewari, Richard Sarle, Ashok Hemal, James O Peabody, Guy Vallancien
Journal of Urology September 2003
5 15-year biochemical failure, metastasis, salvage therapy, and cancer-specific and overall survival rates in men treated with robotic radical prostatectomy for PSA-screen detected prostate cancer
Akshay Sood, Ralph Grauer, Mireya Diaz-Insua, Ashutosh K. Tewari, Ashok K. Hemal, Alok Shrivastava, James O. Peabody, Wooju Jeong, Firas Abdollah, Jan K. Rudzinski,Jack R. Andrews, Michael A. Gorin, Mahendra Bhandari & Mani Menon
Prostate Cancer and Prostatic disease May 2023
