Minimally Invasive Surgical Methods for Prostate Cancer
- 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.
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.