Tuesday, January 31, 2023

What Is Robotic Prostate Surgery

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Open Or Laparoscopic Radical Prostatectomy

Robotic surgery for prostate cancer

In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.

In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.

Rise Of Robotic Radical Prostatectomy

Menon et al from the Vattikuti Urology Institute at Henry Ford Hospital in Detroit, Michigan, are responsible for the development and popularization of robotic radical prostatectomy. This technique has been gaining widespread acceptance in the United States and Europe and is increasing in penetration worldwide. Robotic radical prostatectomy offers the advantages of the minimally invasive laparoscopic approach but shortens the learning curve, facilitating and hastening mastery of the procedure.

Although solid basic laparoscopic skills are required for access and assistance, the console surgeon role requires less laparoscopic skill. Therefore, the procedure is accessible to experienced open-procedure surgeons with minimal or no laparoscopic experience. In a published report, Badani et al have performed more than 2700 robotic prostatectomies and have reported a mean operative time of 154 minutes, a mean blood loss of 100 mL, and hospital stays of less than 24 hours in 96.7% of patients.

The following image provides a portion of a minimally invasive radical prostatectomy.

Go to Prostate Cancer and Laparoscopic Pelvic Lymph Node Dissection in Prostate Cancer for more information on these topics.

When Can I Exercise After Robotic Prostate Surgery

Walking will be permitted right after surgery. Heavier exercise should be postponed for 3-4 weeks.

As is the case with other minimally invasive procedures, robotic surgery has potential advantages over traditional open surgery:

  • Length of hospitalization is often shortened to one or two days.
  • The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss.
  • There is often no need to prescribe narcotic analgesics on discharge. Patients generally need nothing more than Tylenol.
  • Approximately 90% of patients can return to work or resume full activity in only two to three weeks.
  • For prostatectomy, complete continence is obtained in 94% of patients within 6 months.
  • Surgeons are able to perform minimally invasive procedures with more precision. Robot arms remain steady at all times and robot wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles – positions surgeons would have difficulty reaching otherwise. In this way full functionality of the prostate can be preserved in the vast majority of cases.

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What Happens During The Procedure

A full general anaesthetic will be used and you will be asleep throughout the procedure.

The anaesthetist will put a drip into your arm to allow them access to your circulation during the operation. You will be anaesthetised in the operating theatre. During the surgery you will be given antibiotics by injection if you have any allergies, be sure to let the anaesthetist know.

The Da Vinci® prostatectomy is an operation to remove the prostate using a laparoscopic technique but with a more refined instruments controlled by your surgeon using a robotic console, which is placed beside you in the operating theatre.

Attached to the console are four robotic arms three for instruments and one for a high magnification 3D camera to allow the surgeon to see inside your abdomen. The three robotic arms have the ability to hold various instruments attached to them and allow the surgeon to carry out your operation. The instruments are approximately 7mm in width.

The instruments have a greater range of movement than the human hand and, because of their size they allow the surgeon to carry out the operation using 3D imaging in a small space within the body.

Dvc And Urethral Transection

Robot Assisted Radical Prostatectomy

In 2012, we stopped using a stapler as our new nurse practitioner was too small to manipulate the stapler appropriately . So abruptly in September 2012, we switched from the stapler to cutting the dorsal vein and urethra and then oversewing the DVC. Within 612 months we noted dramatic improvement in both continence and early return of erections.

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Are There Any Side Effects

Most procedures have a potential for side effects. You should be reassured that, although all these complications are well recognised, the majority of patients do not suffer any problems after a urological procedure.

Please use the check boxes to tick off individual items when you are happy that they have been discussed to your satisfaction:

Common

  • Temporary difficulties with urinary control
  • Impairment of erections even if the nerves can be preserved
  • Discovery that cancer cells have already spread outside the prostate, including a positive surgical margin whereby cancer cells are present on the surface of the prostate. This may less commonly require further treatments such as radiotherapy or hormone treatment

Occasional

Rare

Types Of Radical Prostatectomy

The prostate gland lies just under the bladder, in front of the rectum. Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.

Open prostatectomy

In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and .

Laparoscopic prostatectomy

In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.

Robot-assisted laparoscopic prostatectomy

Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.

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Control Of The Lateral Pedicles And The Veil Of Aphrodite

The lateral pedicles at the prostate vesical junction are controlled using Hem-o-lock clips and/or bipolar coagulation. The clips are applied close to the prostate, and the pedicle is divided between them . Once the dissection enters the plane between the prostatic fascia medially and the levator fascia laterally, electrocautery is avoided and the anterior nerve-sparing dissection proceeds using sharp cutting with scissors and blunt dissection using the grasper . This dissection proceeds distally to the puboprostatic ligaments.

Several authors have also advocated a completely cautery-free or athermal dissection of the lateral pedicles to avoid any inadvertent damage to the neurovascular bundle. This can be achieved with laparoscopic bulldog clamps and oversewing of the neurovascular bundle for hemostasis. Although results of this technique have not been validated in large series, minimizing the use of cautery or other thermal hemostatic instruments during dissection near the neurovascular bundle seems prudent.

Who Should Undergo Radical Prostatectomy

Robotic Prostate Surgery – The Nebraska Medical Center

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

Before performing radical prostatectomy, doctors first try to establish that the prostate cancer has not spread beyond the prostate. The statistical risk of spread can be determined from tables comparing the results of a biopsy and PSA levels. Further testing for spread, if needed, can include CT scans, bone scans, MRI scans, and ultrasound.

If it appears that the prostate cancer has not spread, a surgeon may first offer other options besides surgery. These can include radiation therapy, hormone therapy, or simply observing the prostate cancer over time, since many prostate cancers grow slowly. Depending on how high the risk of cancer spread, pelvic lymph node dissection may be considered, as well.

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Prostate Surgery Complications And Risks

Surgery is an inherently risky medical procedure. However, for prostate cancer treatment, surgery can be the most effective choice for eradicating malignant tumors without the painful side effects of chemotherapy and radiation therapy.

Among the more serious risks associated with surgical treatment is the possibility of infection at the incision site. Such infections are often the primary cause of serious complications which may hamper a quick and uneventful recovery.

The da Vinci system greatly mitigates the risk of infection during robotic prostate surgery.

First, the size of the incision is significantly smaller with robotic prostate surgery than with the traditional procedure. A standard, non-robotic prostate surgery requires a six- to eight-inch vertical incision to the abdomen. A large, open incision increases the patients susceptibility to bacterial infection during and after the surgery.

Post-operative infections are more common than intra-operative infections, as hospital rooms are not maintained at the same level of sterility in which operating rooms are. The da Vinci robotic prostate surgery system utilizes a much less invasive technique requiring four to five small incisions, each less than two inches.

These smaller incisions will heal significantly faster than the large incision needed in traditional surgery.

Other prostate surgery complications may be:

Will I Have Erectile Dysfunction

Whether or not you experience erectile dysfunction after radical prostatectomy will depend largely on your age, your health and what your erections were like before the operation. This side effect may occur if nerves were injured during the operation.

There are two main nerves running through the pelvis that branch into many nerves covering the prostate. Urologists call them neurovascular bundles because they really are bundles of many nerves. Urologists always aim for nerve-sparing surgery, and we rarely need to remove the neurovascular bundles. But sometimes the bundles are stretched and some of the thousands of nerve fibers within an individual nerve can be damaged, says Mohler. In most men, both neurovascular bundles can usually be spared. If the cancer is advanced, sometimes one or both cannot be.

Benefits of Robotic Radical Prostatectomy

Have more questions about radical prostatectomy? Our experts give you the answers.

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Indications And Contraindications For Minimally Invasive Radical Prostatectomy

Candidates for either laparoscopic or robotic radical prostatectomy include patients in whom the diagnosis and staging support organ-confined prostate cancer and in whom the appropriate metastatic workup results are negative. However, both approaches are contraindicated in individuals who have undergone previous pelvic surgery. Prior benign prostatic hyperplasia surgery, along with large prostate size, pose technical challenges and increase operative times and blood loss during robotic radical prostatectomy.

What Should I Expect Before The Procedure

Urology and Prostate Cancer Services And Treatments San Jose

You will usually be admitted on the day of your surgery. You will normally undergo pre-assessment on the day of your clinic, or an appointment for pre-assessment will be made from clinic, to assess your general fitness, to screen for the carriage of MRSA and to perform some baseline investigations. We will dispense medication for you to take the night before and on the morning of the operation as follows:

Omeprazole 20mg to be taken at 22.00 then night before, and again at 06.00 the morning of your operation .

Glycerine suppositories to be taken the evening before your operation and upon waking on the day of your surgery to help evacuate your bowels.

After admission, you will be seen by members of the Medical team which may include the consultant, junior urology doctors and your named nurse.

One important fact that you must do is to prepare yourself to mobilise immediately after the operation. You should try to walk at least ten lengths of the ward before your operation.

You will be asked not to eat for six hours before surgery. You will be measured for elasticated stockings, which you will be asked to put on to prevent thrombosis in the veins of your legs.

Before your procedure, the Anaesthetic team will visit you to ensure that they have no concerns about anaesthetising you. You are encouraged to ask them questions at this stage about any concerns or issues you have concerning the anaesthetic.

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Urinary Incontinence After Prostate Surgery: Everything You Need To Know

Undergoing a prostatectomy can be difficult. And for many men, finding that they are incontinent post surgery may come as a shock.

But rest assured that there are many treatments available to manage incontinence treatment after surgery. Read below for some of the most common questions we receive about incontinence after prostate surgery.

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Where Can I Find Prostate Cancer Support Groups

Even though once you complete the surgery you most likely will find yourself cancer-free, the anxiety and stress may never totally go away. The support of your friends and family is essential in these moments, but the most relief you will find is among people that have gone through the same experience.

We advise you to search locally for prostate cancer or cancer survivors support groups and discuss your journey in beating this. You will find there plenty of people that lived through the same emotions and painful experiences and you will gather your strength to overcome this and not let it define the rest of your life.

If physical presence is not an option for you, there are plenty of forums and online communities that gather around this subject. You can find people that share their experiences and advice below:

  • https://www.cancerforums.net/forums/14-Prostate-Cancer-Forum
  • http://community.prostatecanceruk.org/
  • http://www.topix.com/forum/health/prostate-cancer

Prostate cancer surgery is not as severe of a surgery as other ones. The recovery, especially after robotic surgery, usually lasts up to 2 to 3 weeks and patients can return to work and to living their normal lives.

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How To Reduce Health Risks From A Gas Stove

An operation called a radical prostatectomy has long been a mainstay of prostate cancer treatment. Offered most often to men whose cancer has not yet begun to spread, it involves removing the entire prostate gland, and can be performed in different ways. With the traditional open method, surgeons remove the prostate through an 8- to 10-inch incision just below the belly button. Alternatively, surgeons can perform a robot-assisted radical prostatectomy. With this approach, miniaturized robotic instruments are passed through several much smaller incisions in the patients abdomen. Surgeons control these instruments remotely while sitting at a console.

At least 85 percent of all radical prostatectomies in the United States today are performed robotically. But how do those high-tech surgeries compare with the traditional open method?

Most studies show no major differences between the procedures in terms of patient survival or their ability to control prostate cancer over the long term. Robotic prostatectomies ostensibly offer quality-of-life advantages for urinary function and sexual health. However, the supporting evidence comes mostly from doctors reports, insurance claims-based data, or studies too small to generate definitive conclusions.

Now, results from a much larger comparative study provide needed clarity.

What Are The Types Of Radical Prostatectomy

Actual demo of robotic surgery for prostate cancer

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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Prostate Cancer Treatment Begins With Your Primary Physician

In most cases once youve been diagnosed with prostate cancer, your primary care physician and/or urologist will assist you with the necessary tests required before prostate surgery. This should be done approximately four weeks before surgery. If you have any questions regarding pre-operative tests please email us or call at .

Your Prostate Surgery Recovery And Follow

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.

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