Thursday, February 2, 2023

How Is The Prostate Removed In Robotic Surgery

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Your Prostate Surgery Recovery And Follow

What is a robotic prostatectomy?

Although rest after the surgery is important for healing, walking is just as important. Resting too long can adversely affect the way you feel and may prolong the healing process. If you were very active before your surgery, you will probably want to resume your regular routine as soon as possible. If you were only moderately active before surgery, it is still important to become active. Be sure to start slowly with more gradual, gentle exercises. Walking is the best way to get back to feeling normal again. We recommend patients take a 1015-minute walk three times a day if possible. You may resume sexual activity per your doctors instruction. There are a few restrictions after surgery:

  • No lifting more than 15 pounds for at least six weeks
  • No bicycle riding, horseback riding, or motorcycle riding for two months
  • Use common sense

Before being discharged from the hospital, you will receive instructions from your nurse and doctor regarding diet, physical activity, and care of the urinary catheter. About one week after discharge, you may be asked to return for a post-op checkup and X-ray. During this visit, it is likely that the catheter will be removed by the nurse, while the doctor checks on your recovery progress. The physician will also review the pathology report of the tissue that was removed during the prostate cancer surgery.

Who Needs A Prostatectomy

Prostate cancer is usually a slow growing cancer. If you have this type of prostate cancer, you and your doctor may decide to watch the cancer by doing blood tests, prostate exams, and prostate biopsy. In many cases, surgery is never needed.

Some prostate cancers grow quickly. These cancers can cause death if not treated. In fact, prostate cancer is the second leading cause of cancer deaths in men. Cancers that grow quickly are called aggressive. When you have a biopsy to diagnose prostate cancer, the cells will be examined and given a score for aggressiveness. This is called a Gleason score. A Gleason score less than 6 is a slow growing cancer. A score of seven is in the middle, and a score of 8 to 10 is aggressive. Prostatectomy may be the best treatment for an aggressive cancer.

What Are The Benefits To Patients Who Have Laparoscopic And Robotic Prostate Cancer Surgery

The benefits are similar between robotic and laparoscopic prostate surgery. Patients are usually able to go home the day after prostate surgery, and can return to daily living activities as early as 7-10 days after surgery. Patients undergoing open surgery generally have 4-6 weeks before they can resume routine daily living activities, generally experience less post-operative pain and discomfort and have a faster recovery. They also experience significantly less intraoperative bleeding. Robotic and laparoscopic prostatectomy uses small incisions and is highly precise the risk of incontinence is low and the surgical technique is continuously refined to improve potency.

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Advent Of Robotic Surgical Technology

The next significant advance in the surgical treatment of localized prostate cancer was the development of robotic surgical technology. Initially developed by the United States Department of Defense for use in military battlefield applications, robotic technology was adapted for civilian use through the entrepreneurial efforts of 2 rival corporations, Intuitive Surgical, Inc, and Computer Motion, Inc. These companies simultaneously developed robotic interfaces for use in human surgical applications. Computer Motion, Inc, introduced the Zeus Surgical System at approximately the same time that Intuitive Surgical, Inc, developed its da Vinci Surgical System.

Both technologies relied heavily on a laparoscopic patient-robot interface in which instruments were placed through small trocars implanted in the patients skin. The working field was maintained predominantly by insufflation of the peritoneal cavity with carbon dioxide. Subsequently, Intuitive Surgical, Inc, acquired Computer Motion, Inc, consolidating the robotic surgical technology and making Intuitive Surgical, Inc, the sole provider of advanced robotic technology for use in human surgical procedures.

Several other companies also develop and manufacture robotic surgical technology, including single robotic arms for laparoscopic cameras or as part of integrated minimally invasive operating-room systems, but none of these rival technologies can compete with the advanced robotic engineering by Intuitive Surgical, Inc.

The Steps Of The Robotic Prostatectomy

Robot Assisted Radical Prostatectomy

Robotic prostatectomy requires 5 small incisions, each about one-quarter of an inch in the lower abdomen, through which instruments are inserted. A sophisticated video camera is one of the instruments, which gives Dr. Samadi a three-dimensional, 10x magnified field of vision. The keyhole incisions drastically reduce blood loss and the camera provides unprecedented visual clarity. The result is a clear surgical field during the prostatectomy with nothing to obstruct Dr. Samadis view of the prostate and surrounding tissue.

Cameras are also used in laparoscopic prostatectomy, but they provide only a two-dimensional image and no magnification.

The prostate surgery follows these specific steps:

  • Keyhole incisions are being made in the patients abdomen
  • Fine robotic instruments are being placed inside the abdomen
  • A 3D endoscope and an imaging device is being placed inside the abdomen for enhanced precision
  • The surgeon operates the console to maneuver the instruments so as to cut and remove the prostate
  • The prostate is being removed through one of the keyholes
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    How Is Urinary Incontinence After Prostate Surgery Treated

    If you find youre having issues with mild to moderate leakage after surgery, your healthcare provider might suggest starting with noninvasive therapies like medications or physical therapy exercises for the pelvic floor muscles. These treatments may also cut down on the number of times that you have to get up each night to pee.

    These methods can sometimes help men who have mild to moderate leakage. Men who have persistent leakage or a more severe problem may need surgery if they do not want to continue to use pads.

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    Surgery For Prostate Cancer

    Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.

    The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.

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    Figure 2 Practice Makes Perfect

    The likelihood that a surgeon performing laparoscopic prostatectomy will have to switch to open abdominal surgery in order to complete the operation goes down significantly with practice, measured in the number of operations performed.

    Source: Journal of Urology, July 2005.

    Did he mention anything about the visualization of the neurovascular bundles?

    Yes, he felt pretty confident that with the increased magnification, he would be able to move them aside, and remove the prostate with no problem. He said, If the cancer has spread into the seminal vesicles, then obviously we have to deal with that. And we wont know until the operation. But he seemed pretty confident that after the operation Id be in good shape.

    Did you consider having robotic surgery closer to home?

    You know, I did look into it. But I did some research, and it looked like there werent many people doing this at the time in the city where I live, and they didnt have a lot of experience. One surgeon had done 50 of these operations. The doctor I met with had done about 400. So Im thinking, Okay, 50 versus 400. I think Ill go with the guy whos done 400.

    What kind of logistics were necessary, with you being in one city and the operation being done in another?

    There were some logistical challenges. I ended up doing the preoperative testing at a hospital near my home, and then had it sent to the surgeon in the other city. He was willing to accept their medical tests.

    How long did you have it in place?

    Surgeon Console For Robotic Prostatectomy

    Robotic Prostate Surgery

    The surgeon operates while seated comfortably at the da Vinci Surgeon Console, an ergonomically designed console viewing a 3-D image of the operative site. As the surgeon moves his hands, wrists, and fingers, the instruments are performing the same movements inside the patients body.

    The da Vinci Robotic System is able to scale the doctors motions and translate them into the operating arms during robotic prostate surgery.

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    What Happens During Surgery

    Your surgeon will put a small needle just below your belly button, into your abdominal cavity. The needle is connected to a small tube that passes carbon dioxide into the belly. This lifts the abdominal wall to give the surgeon a better view once the laparoscope is in place.

    Next, a small cut will be made near your belly button. The laparoscope is placed through this incision and is connected to a video camera. The image your surgeon sees in the laparoscope is projected onto video monitors placed near the operating table.

    Before the surgery, the surgeon will take a thorough look at your abdominal cavity to make sure the laparoscopy procedure will be safe for you. If the surgeon sees scar tissue, infection, or abdominal disease, the procedure will not be continued.

    If the surgeon decides the surgery can be safely performed, more small cuts will be made, giving them access to the abdominal cavity. If necessary, one of these small incisions may be enlarged to remove the pelvic lymph nodes.

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    Why Might I Need A Robotic Prostatectomy

    Prostatectomy is used to treat prostate cancer that is confined to the prostate gland and the seminal vesicles. The robotic system can help your surgeon in several ways. The camera magnifies the area, helping the surgeon see tiny structures more clearly. The robotic system can make steady, precise movements in small places that the surgeon may have trouble reaching otherwise.

    Compared with a standard open surgery, this type of surgery may have benefits. These include:

    • Faster recovery
    • Trouble controlling urine, called incontinence
    • Trouble getting or keeping an erection

    There may be other risks, depending on your specific health condition. Talk with your healthcare provider about any concerns before the surgery.

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    Robotic Radical Prostatectomy Versus Laparoscopic Or Open Surgery

    Robotic radical prostatectomy offers significantly lower operative times and blood loss than laparoscopic or open surgery. Catheterization times and hospital stay are also superior to those associated with open and laparoscopic approaches. The learning curve is less with robotic assistance compared with laparoscopy. The one significant question that remains unanswered pertains to the cost-effectiveness of robotic prostatectomy compared with open and laparoscopic radical prostatectomy.

    A randomized controlled phase 3 study by Yaxley et al that compared robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy reported that both techniques had similar functional outcomes at 12 weeks. Urinary function scores and sexual function scores were not significantly different between these two groups at 6- and 12-weeks post-surgery.

    Early functional results are are summarized in Table 4 below.

    Table 4. Outcomes of Functional Parameters Using Robotic Radical Prostatectomy

    Series

    Badani et al

    2766

    Ahlering et al

    96% at 6 mo

    IIEF = International Index of Erectile Function.

    Preliminary results from the above series show that oncologic and functional results following robotic prostatectomy compare very favorably with those of either open or laparoscopic radical prostatectomy. The margin rates and rates of prostate-specific antigen recurrence are similar, but potency and continence rates are better than those of open and laparoscopic approaches.

    Should I Have A Needle Biopsy Of The Tumor Prior To Tumor Removal Surgery

    Robotic Prostatectomy For Prostate Cancer

    Traditionally, biopsies are rarely performed for kidney tumors due to risks of bleeding, tumor spread and false diagnosis. With improved technology, emerging evidence suggests that biopsy is safe and accurate. LLUMC offers renal biopsy for select patients. Once the tumor is removed from the body, a pathologist will formally evaluate to determine what kind of tumor it is.

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    Incision Of The Dorsal Venous Complex And Urethra

    This is the final step of the dissection. Using a 0° lens with 1:3 scaling, the dorsal venous complex is incised tangentially to the prostate to avoid capsular incision. A plane between the urethra and dorsal venous complex is gently developed to expose the anterior urethral wall. The Foley catheter is reinserted and used to identify the anterior surface of the urethra at the urethroprostatic junction. The anterior wall of the urethra is transected with the scissors a few millimeters distal to the apex of the prostate .

    The posterior wall of the urethra and the rectourethralis muscle are cut under direct vision. The freed specimen is then examined for adequacy of resection margins and is placed in a specimen-retrieval bag.

    Facts Every Man Should Know Before Prostate Cancer Surgery

    Many men want to know what prostate cancer surgery is like, including what to expect before surgery and what to expect afterwards.

    Here are my findings based upon more than 1,000 phone calls to men the day before surgery, almost 700 visits to men the day after surgery and hundreds of calls from men in the weeks following surgery.

  • Most men experience very little surgical pain â probably 80 percent are like meâ¦I had my surgery on a Monday by Friday I was at a graduation party . I got by with only Advil for pain relief. Itâs been described as feeling like they did too many sit-ups.
  • Men really fear the catheter. I let them know that they will be asleep when it is put in. They may be like me and sleep very well with it in. Changing bags from a large capacity night bag to a smaller capacity day bag is simple and doesnât involve removing the catheter. Walking with the day bag catheter is not a problem. Removal of the catheter is usually done in the doctorâs office after the prescribed timeframe and is relatively pain-free.
  • If all goes as planned, you will be walking the night of surgery and then the next day. Most men go home the following afternoon, unless they are otherwise directed by the doctor.
  • Your biggest discomfort may be from gas pains, hence the walking. For a robotic surgery, they have to fill the body cavity with gas to manipulate the equipment. Until we get rid of the gas in the normal way we do, there can be discomfort.
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    Our Primary Goal Is Cancer Cure

    Overcoming cancer is our goal. Secondary goals, which also critically important, include speedy physical recovery, continence recovery, and erection recovery. Statistically, 10% of men can have an erection that supports intercourse within six weeks following surgery. About 50% of men reach this level of function at six months and about 85% will achieve normal function at one year. Recovery of erections is affected by the level of function before the surgery, age of the patient, the presence of other medical problems like diabetes and high blood pressure, while smoking, alcohol intake, stress, your partner, and a few other things are also a factor. In short, it is complicated.

    What Makes The Robotic Prostatectomy A Superior Prostate Cancer Treatment

    daVinci Robotic Prostatectomy Video

    The da Vinci robotic prostate cancer surgery system is able to provide superior clinical prostate cancer treatment results when compared to non-robotic traditional and scope-assisted procedures.

    This is because the da Vinci systems Surgeon Console is equipped to provide the surgeon with a revolutionary, three-dimensional, multi-level magnification spectrum.

    More traditional scope-assisted surgery typically provides a much lower resolution image, and a far more limited field of vision. Furthermore, the da Vinci systems sensitive electronics and one-centimeter diameter surgical arms allow the surgeon to make highly precise movements inside the incision during robotic prostate cancer surgery. This means that the malignant tissue can be removed with efficiency and ease unheard of prior to the era of robotic surgery. This greater precision reduces the likelihood of relapse due to missed cancerous tissue.

    The precision of the da Vinci system also allows the prostate surgeon to avoid damaging healthy prostate tissue, which improves clinical results, reduces scar tissue build-up, and contributes to an overall shorter recovery period after robotic prostatectomy.

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    What Are Laparoscopic And Robotic Surgery

    Laparoscopic and robotic prostate surgery are minimally invasive techniques for performing surgery. Both these procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally invasive surgery with advanced robotic technology.

    What Are The Types Of Radical Prostatectomy

    Your surgeon will choose among several types of radical prostatectomy:

    • Open radical prostatectomy: During this traditional type of surgery, your surgeon makes a vertical incision between your belly button and pubic bone. Your surgeon inserts tools through the incision to remove the prostate and surrounding tissue.
    • Robot radical prostatectomy: Your surgeon makes several small incisions or one single incision across your abdomen. During the surgery, your surgeon operates state-of-the-art robotic controls outside your body. They can see the surgical area with a magnified view on a 3D screen.

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    When You Might Have A Radical Prostatectomy

    Your doctor might recommend a radical prostatectomy if:

    • your cancer hasn’t spread outside the prostate gland. This is localised prostate cancer
    • your cancer has broken through the covering of the prostate and spread to the area just outside the prostate gland. This is locally advanced prostate cancer
    • you are well enough to have this operation

    The aim of a radical prostatectomy operation is to cure prostate cancer.

    Prostate Cancer Risk Factors

    Robotic Prostatectomy
    • Age over 65 this is the main risk factor for prostate cancer. The older a man gets, the more likely he will develop prostate cancer. This disease is rare in men under 45 years of age.
    • Family History ones risk of prostate cancer is higher if you have a father, brother or son with prostate cancer.
    • Race prostate cancer is more common among African American men and less common among Asian/Pacific Islanders, Native American and Native Alaskan men.
    • Obesity Many studies have shown that obese men have a greater risk of dying from prostate cancer, developing a more aggressive cancer, and experiencing disease recurrence after surgery or radiation therapy.
    • Diet Men who consume high levels of fat are more likely not only to develop prostate cancer but also to develop a more aggressive form of the disease. We recommend adoption of a heart healthy diet with a focus on including vegetables and fruit with every meal.
    • Lifesyle Stress and lack of exercise can be the cause of many common diseases. We recommend maintaining a routine of regular exercise. It is also suggested that you work to identify and reduce the stress factors in your life.
    • Certain Prostate Changes men with cells called high grade prostatic intraepithelial neoplasia may be at increased risk for prostate cancer.
    • Certain Genome Changes research suggests that the risk for prostate cancer many be linked to specific changes on particular chromosomes.

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