- Da-Vinci Robotic Laparoscopic Prostatectomy
- Standard Laparoscopic Prostatectomy
Standard Laparoscopic Radical Prostatectomy (LRP)
This is a minimally invasive procedure that removes the entire prostate like open
surgery, but is associated with minimal pain and faster recovery. In this procedure, a
small telescope is placed into the abdomen through the naval. Pencil thin instruments
held by the surgeon are introduced via small incisions in the abdomen. Using these
microscopic instruments, the surgeon performs the operation, removing the prostate
and seminal vesicles, while avoiding trauma to the surrounding tissue. The prostate and
seminal vesicles are removed intact (in one piece) and delivered outside the body
through the naval. A nerve sparing procedure can be performed to maintain the patient’
s pre-surgical level of sexual function.
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Da-Vinci Robotic Prostatectomy and Pelvic Lymph Node Dissection (DVP)
This is also a minimally invasive procedure that allows for the entire operation to be
performed through very small skin incisions. There is faster recovery and little pain,
since open surgery is avoided. As in LRP a small telescope is placed into the abdomen
through the umbilicus and pencil thin instruments are introduced via small incisions in
the abdomen. The operation is performed by the surgeon controlling these microscopic
instruments, gently freeing the prostate and seminal vesicles and avoiding trauma to
the surrounding tissue. The prostate and seminal vesicles are removed intact (in one
piece) and delivered outside the body through the umbilicus. Lymph nodes are similarly
removed. The bladder is then attached back to the urethra. Nerve Sparing
Prostatectomy is accurately accomplished to maintain the patient’s pre-surgical level of
sexual function.
This procedure has been made more precise using the state-of-the-art Da-Vinci
surgical system. This computer enhanced surgical system is comprised of two
components, robotic arms that hold the pencil thin surgical instruments, and a surgeon’
s console that controls the robotic arms. The robot’s surgical instruments move to the
direction of the surgeon’s hands, while the surgeon views the operative field through a
3-D TV screen. The tips of these tiny instruments have six degrees of freedom,
allowing for movements like a tiny wrist around the prostate. Non-robotic surgical
instruments (open or laparoscopic) cannot move in this manner and do not have this
degree of range of motion and flexibility. The highly magnified 3-D viewing screen
allows the surgeon to feel “immersed” within the patient, thereby aiding in the
differentiation between healthy and diseased tissue. In effect the surgeon accurately
removes the prostate and pelvic lymph nodes, while preserving the vital structures such
as the neurovascular bundles responsible for erections and pelvic floor muscles
responsible for quick recovery of bladder control.
Advantages of Da-Vinci Robotic Laparoscopic Prostatectomy
Since this is a minimally invasive procedure, there is relatively less pain and faster
recovery compared to open surgery. Furthermore, the 3-D imaging and the Endowrist
technology makes the surgery more accurate and precise than open or standard non
robotic laparoscopic prostate surgery. This results in higher chance for cancer cure,
more precise dissection of nerve bundles and preservation of erectile function.
There is also less blood loss and shorter hospital stay. Patients usually stay 1 to 2
days in the hospital, followed by 2-3 weeks of recovery at home before resuming all
normal activities. Many patients return to work and sports activities such as running,
weight lifting, golf, tennis within two weeks after surgery.
Nerve Sparing Prostatectomy is accomplished with high degree of accuracy. Patients
have an excellent chance at maintaining their sexual function, thus avoiding long term
impotency. Bladder Neck Sparing techniques can also be used. This allows faster
recovery of urinary control. Subsequently, patients regain bladder control very quickly
after DVP.
As with open surgery, this technique is highly effective and offers a high chance of cure
from prostate cancer. Some urologists would argue that surgery results in the highest
chance of cure from prostate cancer. Da Vinci Robotic Laparoscopic Prostatectomy
(DVP) achieves rapid removal of PSA from blood stream, and provides accurate
information on the true stage and grade of the cancer, including the status of lymph
node involvement
The patient will know if he is cancer free within a month after surgery, as opposed to up
to two years after radiation. Upon removal of the prostate gland and the cancer, the
PSA rapidly drops and reaches an undetectable level within a month. Therefore, the
patient can rest assured of his cancer free status very early after surgery.
Because this surgery is minimally invasive, many of the disadvantages associated with
open surgery are alleviated. Patients are relatively pain free. There is relatively much
less chance of bleeding complications. Da-Vinci Prostatectomy is an excellent surgery
for Jehova’s Witnesses with prostate cancer. Those who want to avoid the need for
transfusion, are excellent candidates for this procedure, since it is associated with
minimal blood loss. Furthermore, return of bladder control, resolution of incontinence,
and return of erections generally occur rapidly.
Disadvantages of Da-Vinci Robotic Prostatectomy
This procedure is highly technical. Most physicians performing prostate surgery have
not been trained in this procedure. Therefore, it is not available at all locations,
requiring the patient to travel to an experienced surgeon and robotic surgery center. It
is recommended that these procedures be performed by urologic surgeons trained in
oncologic surgery with extensive laparoscopic and robotic surgical experience. It is
recommended that the surgeon performing robotic laparoscopic prostatectomy have
done at least 200 of these procedures. The procedure should be done at centers of
excellence, supporting high tech robotic programs. Although adverse effects are rare,
they could include incontinence, erectile dysfunction, possible formation of blood clots
in the leg veins, and infection.
