Robot-Assisted Prostatectomy
Robot-assisted radical prostatectomy is a minimally invasive procedure done to treat patients diagnosed with prostate cancer. This treatment option is the preferred surgical approach to removing prostate cancer. The only FDA approved robotic surgical system is known as the da Vinci® Surgical System . This platform provides improved vision and instrumentation over standard laparoscopic tools thereby allowing a minimally invasive approach leading to quick recovery and fewer complications.
Who Needs Robot-Assisted Prostatectomy?
When prostate cancer is diagnosed and the Gleason score indicates intermediate to high risk, definitive treatment in the form of surgery or radiation is usually recommended. However, when men are healthy and have a long life expectancy, then surgery is usually preferred as the cure rates are higher than with radiation especially when dealing with high risk prostate cancer.
How Surgery is Done
Miniaturized robotic instruments will be placed through five or six small keyhole incisions into the patient’s abdomen to allow the surgeon access to the prostate and nearby tissues. The procedural steps are virtually the same as has been done through a much larger open incision. This approach is significantly less invasive than the traditional open prostatectomy, which requires an abdominal incision that extends from the belly button to the pubic bone.
During the procedure, the surgeon views a three-dimensional magnified picture transmitted via an endoscope and image processing equipment at a console. From this console the surgeon can control the wristed instruments to preserve all the delicate structures surrounding the prostate gland (e.g., blood vessels, nerves, and muscles) and ensure optimal preservation of these vital structures. The bladder is then reconnected to the urethra and a catheter is placed to allow this repair to heal. The surgeon will then remove the prostate by enlarging one of the keyhole incisions.
Benefits of Robot-Assisted Prostatectomy
Compared with traditional open surgery which required 2-4 days in the hospital, patients who undergo robot-assisted radical prostatectomy usually stay in the hospital only overnight, and some centers send patients home the same day. In addition, there is much less blood loss that allows for more energy after surgery. Patients experience fewer complications undergoing robotic surgery. Patients can usually go back to work all day after 2 weeks and go back to all exercise by three weeks while this may take three months after open radical prostatectomy.
Comparatively, regarding cancer cures, robot prostatectomy provides the highest cure rates. In addition, if men do have a recurrence after prostatectomy, then radiation can be used which can then significantly boost cure rates.
Potential Risks and Side Effects
The potential risks of robotic-assisted laparoscopic radical prostatectomy include those found in any surgery such as bleeding, infection at the surgical site, and possible damage to adjacent tissue and organs, however all these events are very rare. There is also the risk of general anesthesia.
The two most concerning expected side effect after surgery are incontinence and impotence.
- Urinary incontinence (inability to control urine): The typical leakage that men have after surgery is called stress incontinence (i.e. leakage) with coughing, sneezing, twisting, bending, etc. As men continue Kegel exercises after surgery, the pelvic floor muscles will strengthen, and the leakage goes away for a very high percentage of men over time. However, for many men after surgery, if they were experiencing urinary bother symptoms from an enlarged prostate then they will experience marked improvement of their urinary symptoms.
- Erectile dysfunction (impotence): After a prostatectomy, the return of erectile function is based on the patient’s age, degree of preoperative sexual function, and whether the nerves were spared during surgery. Unless the surgeon suspects cancer in the nerve tissue, he or she will use nerve-sparing techniques during robotic prostatectomy to minimize the impact on sexual function. If men had good function beforehand and nerve sparing is possible because the cancer is confined to the prostate, these men usually will do well in recovery.
The Recovery Process
The patient will stay in the hospital for one night before being discharged. We usually send patients home the same day. They will receive pain medication to manage symptoms for the first few days, but most men will take only Tylenol.
One week after surgery, the catheter will be removed at the doctor’s office. Patients can usually return to work all day after two weeks and resume all exercise by three weeks.
The PSA will be monitored closely and should read less than 0.2. This will be checked every three months the first year, every six months up to the end of year five, and then annually.
