Robotic Prostatectomy Surgery

Also known as robotic prostatectomy, this minimally invasive procedure is performed with the assistance of advanced surgical technology and an experienced laparoscopic surgery team.

Robotic-assisted radical laparoscopic prostatectomy is accomplished using the da Vinci® Surgical System, a sophisticated robotic surgery system that allows surgeons to operate on the prostate with enhanced vision, control and precision.

Using the advanced surgical system, miniaturized robotic instruments are passed through several small keyhole incisions in the patient’s abdomen to allow the surgeon to remove the prostate and nearby tissues with great precision. This is much less invasive than a conventional radical retropubic prostatectomy, which involves an abdominal incision that extends from the belly button to the pubic bone.

During robotic-assisted radical prostatectomy, a three-dimensional endoscope and image processing equipment are used to provide a magnified view of delicate structures surrounding the prostate gland (e.g., nerves, blood vessels and muscles), allowing optimal preservation of these vital structures. The prostate is eventually removed through one of the keyhole incisions.

For most of the surgery, the surgeon is seated at a computer console and manipulates tiny wristed instruments that offer a range of motion far greater than the human wrist. The surgery is performed without the surgeon’s hands entering the patient’s body cavity.

Benefits of Robotic Surgery

Compared with traditional open surgery, patients who undergo robotic-assisted radical prostatectomy experience:

  • Less blood loss
  • Less pain
  • Shorter hospital stays
  • Faster recovery times (although catheter needs to remain in bladder for same amount of time after robotic or open procedure).

Risks of Robotic-Assisted Laparoscopic Radical Prostatectomy

The potential risks of robotic-assisted laparoscopic radical prostatectomy include the following:

  • Bleeding
  • Infection at the surgical site
  • Adjacent tissue/organ damage

Side Effects of Robotic-Assisted Laparoscopic Radical Prostatectomy

The rates of major side effects from robotic-assisted laparoscopic radical prostatectomy are about the same as open surgical approaches. The most common side effects include the following:

  • Urinary incontinence (inability to control urine): Similar to open surgery, urinary incontinence can occur following a robotic prostatectomy. However, this side effect often improves over time.
  • Erectile dysfunction (impotence): The return of erectile function following prostatectomy is based on the patient’s age, degree of preoperative sexual function and whether the nerves were spared during surgery. Unless cancer is suspected in the nerve tissue, surgeons will use nerve-sparing techniques during robotic prostatectomy to minimize the surgical impact on sexual function.

Prostate Cancer: When to Treat Versus When to Watch

Because certain prostate cancers grow very slowly, your doctor might determine that it’s not likely to present a significant threat to you. This is particularly true if a prostate cancer is localized, meaning it hasn’t spread beyond the prostate.

If that’s the case, you and your doctor can discuss getting regularly tested instead of undergoing treatment right away. Doctors call this approach active surveillance. By not rushing into treatment for a cancer that may not cause you any harm, this approach helps many men avoid treatment-related side effects.

Active surveillance , or active monitoring, means your doctor will monitor you closely, watching to see how the cancer progresses, if at all. This is primarily for cancers that doctors classify as:

  • Slow-growing
  • Very low risk for causing symptoms

To monitor a low-risk prostate cancer, someone on active surveillance could undergo:

  • Rectal exam : Every six months
  • PSA test : Twice a year. This blood test, commonly used to screen for prostate cancer, measures how much prostate-specific antigen (PSA) is in your blood.
  • Biopsy : Once a year (until and unless your doctor determines a less frequent biopsy is warranted)
  • MRI scan : Necessary in some cases to show more details of a cancer if your doctor has any questions or concerns from your test results

Prostate Cancer Treatment: When Watching May Be Enough

Your doctor will consider many factors before deciding whether this approach is right for you. This includes:

  • Gleason score : This scoring system grades how aggressive a prostate cancer is. It also gives doctors hints as to how likely a cancer is to spread. Gleason scores less than 7 are considered lower risk and might be appropriate for active surveillance.
  • Biopsy results : A prostate biopsy (removing tissue samples from the prostate) is the only definitive way to diagnose prostate cancer today. After a prostate biopsy, your doctor will count how many of the samples contain cancer. For biopsies that show three or fewer samples (or cores) with cancer, your doctor might recommend watching you before starting treatment.
  • PSA results : A PSA test is the standard way doctors assess prostate cancer risk. Doctors use PSA test results along with information about your prostate size to measure your PSA density. If PSA density is less than 0.15, you might not need treatment right away.
  • Physical characteristics : Another way your doctor will assess prostate cancer is through a rectal exam. If he or she can’t feel a cancer (via a hard nodule, for example), that’s another sign that could point to active surveillance as a possible treatment approach.

Source: Robotic Prostatectomy | Johns Hopkins Medicine

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This 3d medical animation provides an overview about the anatomy of the male urogenital system, with the main focus on the prostate. Prostate cancer is shown developing in the tubular ducts of the prostate. All of the general steps are then demonstrated in the animation to show how the cancerous prostate will be robotically removed during a minimally invasive procedure.

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