Robotic Surgery for Prostate Cancer
Robotic prostatectomy is the most commonly performed robotic urological procedure. It offers specific advantages over traditional open surgery regarding decreased blood loss, less pain, earlier hospital discharge and more rapid recovery (image prostate incision comparison). In addition to cancer control, any surgical approach to radical prostatectomy attempts to minimize the side effects associated with prostate removal, including stress urinary incontinence and erectile dysfunction. The ability to minimize these side effects in the long-term are enhanced with robotic surgical technology.
How a Robotic Prostatectomy is Performed
The procedure of robotic prostatectomy involves first inflating the abdomen with carbon dioxide gas so that the 3-D high definition robotic camera can be used to visualize the internal structures of the abdomen. The robotic working instruments are then inserted through the skin into the abdomen by placing special access ports calledtrochars. Trochars are 8 mm in diameter and have a valve mechanism to prevent the pressurized gas from escaping while permitting the passage of small instruments required forsurgery. At this point the robot is then “docked” whereby the robotic patient cart (see robot docking image) is brought to the bedside and the arms of the robot are attached to the camera port and robotic trochars.
The “robot” is motionless without the surgeon. Once docked, the surgeon takes full control of the camera and all robotic arms through a sophisticated surgeon console that is in the operating room (seen below – surgeon console Si). Inside the surgeon console the surgeon has the advantage of magnified three-dimensional high-definition vision of the operative field (see inside view). A bedside assistant is required to assist the surgeon with retraction, suction, and the delivery of instruments for suturing and other surgical techniques. Depending on the specific characteristics of each patient’s prostate cancer and other attributes, Dr. Berkman may perform an enhanced or standard nerve-sparing procedure. In certain instances where there is concern or evidence that the cancer is locally invasive, the neurovascular bundle may need to be excised to maximize the chance of cancer cure. Dr. Berkman will discuss all options and the surgical plan with you prior to surgery. In addition, a pelvic lymph node dissection may be performed to determine if there is spread of cancer cells to the lymphatic system. This can be done in a standard or extended fashion and again is dependent upon patient-specific characteristics.
What to Expect After Robotic Prostatectomy
Following robotic prostatectomy patients can expect to leave the hospital the next day after surgery. Patients will go home with a urinary catheter in place. This allows healing of the vesicourethral anastomosis (the region where the bladder is attached to the urethra). The catheter is removed by Dr. Berkman in his office after 7 days. Recovery from robotic prostatectomy can be surprisingly rapid. Because there is minimal blood loss and less pain, men often feel “back to baseline” in just 2 weeks from surgery.