Robotic Prostatectomy for Prostate Cancer
Treatment for prostate cancer sometimes requires surgery to remove the prostate gland. There are two options:
Each approach offers advantages and disadvantages. In the Prostate and Urologic Cancer Program, a complete team of prostate cancer experts evaluates each patient to determine the best surgical method based on the patient’s individual cancer stage, risk and personal priorities.
Overview of Robotic Prostatectomy
Robotic prostatectomy using the da Vinci® robotic surgical system is an innovative, minimally invasive procedure for prostate removal.
A robotic prostatectomy is performed laparoscopically through a series of small incisions. In comparison, a traditional open prostatectomy requires a single large incision of 4 to 5 inches.
The small incisions result in a shorter post-operative recovery and a faster return to normal activities, which are the main benefits of robotic prostatectomy. Another benefit of smaller incisions is less scarring. Robotic surgery also results in less blood loss than open prostatectomy. However, the difference is small, and it does not translate into a difference in the need for blood transfusion.
Regarding other important outcome measures, available data suggests potency and continence rates are similar between the two approaches. Longer follow-up with robotic prostatectomy will be needed to determine if cancer control rates are the same as those achieved by open surgery.
Special Training in Robotic Surgery
The da Vinci® robotic surgical system is designed to help the surgeon see bodily structures clearly and perform surgery precisely. Magnification and 3-D visualization tools provide an enhanced view of the prostate, nerves, bladder and surrounding structures. The system offers the surgeon the same dexterity as the human hand by “translating” the surgeon’s hand movements into the precise movements of the robot’s micro-instruments. Precision movement is important when trying to avoid the nerves that control urinary and sexual function.
Because every surgical maneuver is performed with direct input from the surgeon, the robotic system must be operated by a surgeon trained in minimally invasive robotic surgery.
During the robotic procedure, a patient is placed under general anesthesia and positioned on his back. The surgeon makes six small incisions in the patient’s abdomen.
Hollow cylinders called ports are placed in the incisions, and an operating telescope, camera and surgical instruments are inserted through the ports and into the abdomen. The robot is then positioned at the operating table, and the robotic arms and camera are connected to some of the ports. The surgeon sits at a console a few feet away from the patient, controlling the robotic arms and camera. The surgeon views the surgical area through 3-D goggles, which provide fine details of the body structures.
Once the prostate has been detached from surrounding structures and the urethra (urine tube) has been reattached to the bladder, the robotic arms are removed from the patient. The incision near the navel is enlarged so the entire prostate gland can be removed at once. This is important so that a pathologist can accurately determine the stage of the cancer. All of the instruments are removed, and a temporary urinary catheter and abdominal drain are left in place before the patient is awakened from anesthesia.
While all precautions are taken to reduce the likelihood of complications, no surgical treatment is completely without risk. Potential complications include infection, bleeding requiring blood transfusion, urinary incontinence, erectile dysfunction, port-site hernia and injury to adjacent organs.
What to Expect After Surgery
After surgery, patients usually spend one or two days in the hospital. During the first day, the patient recovers from anesthesia and receives intravenous (IV) pain medication. By the next day, oral pain medication is usually sufficient. Once pain is under control and bowel function begins to return, patients are ready for discharge.
Patients are discharged home with the urinary catheter, which usually remains in place for about one week. During this time, patients are encouraged to walk often. They may shower, but should avoid swimming or sitting in a bathtub.
Patients then return to the Urology Clinic at Froedtert & the Medical College of Wisconsin for a cystogram (an X-ray of the bladder) to ensure adequate healing has occurred and the catheter can be removed.
Urinary control returns after varying lengths of time. Patients are encouraged to wear an absorbent pad initially while they work to retrain the muscles involved in urinary control. Kegel exercises, which strengthen the muscles supporting the urethra, bladder and rectum, are quite helpful. Heavy lifting should be avoided for about four weeks to avoid the formation of hernias at the incision sites.
At the time of the catheter removal, the pathology report concerning the stage of the cancer is shared with the patient. While follow-up treatment will be based on report results, most patients only need to have their PSA level checked on a regular basis. The first follow-up PSA should be checked three months after surgery and then every six months for the immediate future.