Thursday, September 22, 2022

Is Robotic Prostate Surgery Safe

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Why Is There Less Blood Loss With Robotic

Robotic Assisted Laparoscopic Radical Prostatectomy | Brigham and Women’s Hospital

The use of the robotic equipment in surgery means a more precise and less disruptive dissection, which helps control potential sources of bleeding. Blood loss is also reduced because of the pressure generated by the gas used in inflate the abdomen during surgery, which provides surgeons with a better and more expansive view of the operating area around the prostate.

What Is Robotic Prostate Surgery

A surgical treatment for prostate cancer, the radical prostatectomy procedure removes the entire prostate gland. Radical prostatectomy can now be done by laparoscopic or robotic techniques. In open prostate surgery, the prostate gland is removed through a larger incision in the lower abdomen. Laparoscopic prostate surgery involves key-hole incisions which used for inserting a lighted viewing instrument into the pelvic region and allows examination and removal of the prostate without a large abdominal incision.

Postoperative Care After Prostate Surgery

After a healthy operation and discharge, there are some rules that you must follow. There is a risk of bleeding for the first several months after surgery. Therefore, there are some points to take into consideration. The length of the recovery period after prostate cancer surgery varies depending on some conditions. There are factors such as the type of surgery, the stage of disease, and the patients health status. However, overall recovery time is short.

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Why Are Robotic Surgeries Better Than Traditional Open Surgeries For Prostate Cancer

In the present time, you can see that robotic prostate cancer surgeon help is taken in the hospital rather than the traditional open surgeries.

There are many reasons for it. One of the most common reasons for using robotic surgeons for prostate cancer than the traditional open surgeries is that there is more surgery done by doctors with the help of robots are more perfect.

Here are some more reasons for using robotic surgeons rather than traditional open surgeries:

Hospitals take the help of robotic surgeons because the robots can help the doctors to complete the surgery within the time without any mistake.

With the help of robotic surgeons or robots, doctors can complete the surgery correctly.

They are more preferred than the traditional open surgeries for prostate cancer because the outcome of the surgery done by doctors with its help is always impressive and helps the patient to recover fast.

Robotic surgeons are mainly Hi-Tech robots which can help the doctors to work more flexibly and better access to internal organs of the patients body.

If the doctors use the robotic surgeon, there will be less chance of making a mistake.

According to other research, robotic surgeons are much better for the surgery of prostate cancer than traditional open surgeries.

What Are The Advantages Of Cleveland Clinic’s Prostate Surgery Program

Tom Shannon

These procedures are performed through small key-hole incisions that do not cut muscle. Laparoscopic and robotic prostatectomy offer surgeons unparalleled visualization of the area, thus permitting precise removal of the prostate. Patients also experience significantly less blood loss. Additionally, patients benefit from:

  • Reduced hospital stay after surgery and faster healing
  • Less postoperative pain and virtually no need for pain medication
  • Earlier removal of catheter
  • Shorter recovery time
  • Quicker return to normal activity and work
  • Smaller “Band-aid” incisions and less scarring

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Does Prostate Cancer Surgery Save Lives

There are two widely referenced studies that have been undertaken by urologists, but largely ignored by them. The PIVOT study published in the New England Journal of Medicine concluded that Among men with localized prostate cancer detected during the early era of PSA testing, radical prostatectomy did not substantially reduce all-cancer or prostate cancer mortality, as compared with observation , through at least 12 years of follow up. Absolute differences were less than 3 percentage points . In other words, despite undergoing this risky invasive surgery, it offered zero protection against dying from prostate cancer and, according to Horan, without proof of life extension in man or animal that would satisfy the committee on medical experimentation at Nuremberg.

The other radical prostatectomy study commonly referenced had a 29 year follow-up and claimed a mean of 2.9 years of life gained. However this study also, was hopelessly flawed and skewed towards a semblance of life extension because men with Gleason 6 pseudo-cancer were included while others received arbitrary additional interventions such as testosterone suppression which by itself can extend life.

Side Effects Of Robotic

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 : Similar to open surgery, urinary incontinence can occur following a robotic prostatectomy. However, this side effect often improves over time.

  • Erectile dysfunction : The return of erectile function following prostatectomy is based on the patients 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.

Robotic Prostate Surgery | Q& A

Thanks to advances made by surgeons like Dr. Patrick Walsh, The Brady Urological Institute at Johns Hopkins offers unparalleled prostatectomy expertise. Learn more about prostate cancer surgery and the difference between open and robotic procedures from Dr. Mohamad Allaf.

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Quicker Recovery Period After Robotic Prostatectomy

When a physician determines robotic prostatectomy is the best prostate cancer treatment option, da Vincis robotic technology optimizes the chances of a quicker recovery time as opposed to traditional surgical prostatectomy. The smaller incisions required to maneuver the operating arms heal much faster require fewer sutures, and, therefore, are less vulnerable to tearing or infection.

The precise movements of the robotic arms allow a more targeted approach for cleaner removal of malignant tissue and reducing damage to healthy tissue during robotic prostate surgery. The operating arms of the da Vinci Surgical System are designed to avoid contact between the operating instruments and the walls of the incision. All of these advantages translate to a speedier and less worrisome recovery period.

Prostate surgery recovery time is substantially improved in comparison to open prostatectomy. As mentioned earlier, the much larger incision required in open surgery means pain is greater and recovery takes longer. Dr. Samadis prostate surgery takes just 1.5-2 hours and almost all of his patients return home the day after having a robotic prostatectomy. Around 80% of open prostatectomy patients leave the hospital within the first week.

An Overview Of Da Vinci Robotic Surgery

Tom Had a Quick Recovery after Robotic Prostate Surgery at NWH

Great leaps forward in medical technology have made numerous things possible like minimally invasive surgery. Traditionally, surgery would often require a lengthy hospital stay followed by weeks of recovery and pain. Today, minimally invasive surgical procedures in urology, such as robotic prostatectomy, and many other specialties are performed through small incisions instead of the large incisions needed for traditional surgeries. By using minimally invasive surgery for surgical treatments, such as radical prostate removal , patients typically experience less trauma and pain, minimal scarring, faster recovery and shorter hospital stays. The goal of minimally invasive surgery is to accomplish all necessary internal repairs while leaving the body and surface of organ tissues, including the skin, as natural as it was before surgery. With the help of da Vinci robotic surgery, Dr. Mark Allen, Plano, Frisco and Dallas, Texas area urologist, can return patients to normal activities with less downtime and less pain.

Surgical procedures performed using the non-invasive da Vinci Surgical System provide numerous benefits to the patient such as less risk of infection, less anesthesia, less pain and scarring, faster recovery and a quicker return to normal activities.

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The Columbia Robotic Surgery Team

Assistant Professor of Urology, Columbia University Irving Medical Center

Specialties

Herbert and Florence Irving Professor of Urology

Emeritus Chair, Department of Urology

Specialties

John K. Lattimer Professor of Urology

Director, Urologic Oncology, Columbia University Irving Medical Center

Chair, Department of Urology, Columbia University Irving Medical Center

Specialties

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Urinary Problems After Surgery

Leaking urine

Most men cant control their bladder properly when their catheter is first removed. This is because surgery can damage the muscles and nerves that control when you urinate.You might just leak a few drops if you exercise, cough or sneeze . Or you might leak more and need to wear absorbent pads, especially in the weeks after your surgery.Leaking urine usually improves with time. Most men start to see an improvement one to six months after surgery. Some men leak urine for a year or more and others never fully recover, but there are things that can help and ways you can manage it.

Difficulty urinating

A few men may find it difficult to urinate after surgery . This can be caused by scarring around the opening of the bladder or the urethra .Some men find they suddenly and painfully cant urinate. This is called acute urine retention and it needs treating quickly to prevent further problems. If this happens, call your doctor or nurse, or go to your nearest accident and emergency department.

Watch Paulâs story for one manâs experience of managing urinary problems after surgery below.

Sexual problems after surgery

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How Do Patient Outcomes Compare For Robotic Prostatectomy

Results of studies on robotic prostatectomy indicate that the success rate in controlling prostate cancer with robotic prostatectomy in patients with localized disease is as good as, or better than, open or laparoscopic prostatectomy. Some studies suggest that robot assisted prostatectomy may allow for earlier return of continence and potency.

* Urinary Continence After Robotic

Procedures &  Surgeries

Robotic prostatectomy sets an excellent record of continence. Using the definition of zero pads used per day means men will use no pads, not even security pad, although they may have a few drops of leakage during the day. The percentage of men at this zero pad/day standard is 50% at 1 month, and 75% at 3 months after surgery. The remaining men use either a security pad or some number of pads per day at 3 months.

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Equipment For Robotic Radical Prostatectomy

Currently, the only available integrated robotic surgical system is the da Vinci Surgical System . This computer-aided system has a basic master-slave design. A second generation of this system is currently available .

The surgeon console

This is the user interface of the robot for the surgeon and consists of the following:

  • Display system: The system is a 3-D stereoscopic display for the console surgeon and is generally available for view in 2-D form by assistants and observers.

  • Master arms: These are the controls the surgeon uses for making surgical movements. Movements of the master arms translate to real-time movements of the instrument tips and may be scaled for fine movements. The master arms also provide basic force feedback to the surgeon but are limited in their ability to discriminate complex haptic feedback. Camera movements are controlled with a clutch mechanism. In the 4-arm systems, the surgeon can toggle between instruments.

  • Control panel: The control panel is used to adjust the surgeon console display and control options. The control panel allows toggling between 2- and 3-D display, adjusting various levels of scaling, and choosing the camera perspectives .

  • Central processing unit: This is the computer that controls the system and integrates and translates robot control inputs from the surgeon.

Robotic arms

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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Patient Positioning And Compartment Syndrome

Patient positioning

Proper patient positioning has a critical role in any surgical procedure. It is necessary for adequate exposure and access, and also reduces the iatrogenic injuries as compartment syndrome and peripheral nerve damage.

Intraoperative physiologic changes include increased intraocular pressure, central venous pressure, intracranial and pulmonary venous pressure, and decreased functional residual capacity and pulmonary compliance. Lung functions may be compromised prominently if the patient is too tightly taped to the table. Prolonged Trendelenburg position may result in pooling of the venous blood in upper extremities. Subsequently, head and neck edema may be seen and also re-intubation may be required due to laryngeal edema and posterior ischemic optic neuropathy even after minimally invasive radical prostatectomy. Orbital stretching or direct compression from facedown prone positioning may also cause permanent vision loss.

The absolute mechanism of PION is unknown, but might be the result of optic nerve ischemia. Multiple factors have been proposed as underlying mechanisms of PION but the PION cases after open radical prostatectomy is found to be associated with prolonged hypotension as the result of excessive blood loss. Urologists should immediately consult such patients to ophthalmologists.

Compartment syndrome

Caring For The Catheter

Robotic Prostate Surgery – The Nebraska Medical Center

You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.

To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.

We will provide most of the supplies you need to care for your catheter. They include:

  • StatLock Foley catheter securement device
  • Shaving supplies

You should empty the catheter bag when its half full. This helps prevent air locks from developing in the tubing.

To apply the leg bag:

  • Wash your hands with soap and water.
  • Remove the tape at the joint of the catheter tube and bag.
  • Swab all connecting areas with alcohol pads.
  • Remove the blue clamp.
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    Robotic Prostate Surgery Details

    Using the advanced surgical system, miniaturized robotic instruments are passed through several small keyhole incisions in the patients 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 , 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 patients body cavity.

    What Makes The Robotic Prostatectomy A Superior Prostate Cancer Treatment

    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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    Who Should Get A Radical Prostatectomy

    Men younger than 75 years old with limited prostate cancer and who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.

    Before doing a radical prostatectomy, doctors first try to confirm that the prostate cancer has not spread beyond the prostate. They can figure out the statistical risk of spread by looking at tables comparing the results of a biopsy and PSA levels.

    Other tests to check for signs of spread, if needed, can include CT scans, bone scans, MRI scans, ultrasound, PET scans, and bone scans.

    If it appears that the prostate cancer hasnât spread, your surgeon may first offer you other options besides surgery. These can include radiation therapy, hormone therapy, or simply watching the prostate cancer over time, since many prostate cancers grow slowly.

    Depending on how high your risk of the cancer spreading is, your surgeon may also consider doing an operation called pelvic lymph node dissection.

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