FAQS AT A GLANCEWhat are the benefits to a patient?What about long-term follow-up from robotic assisted prostatectomy?
Since 2004, patients at UC Davis Medical Center have benefited from minimally invasive prostatectomies using a robotic surgical system that enables surgeons to safely remove a cancerous prostate while avoiding the delicate nerves and muscles surrounding it. The surgical robot is completely controlled by a trained surgeon who manipulates mechanical arms from an operating room console near the patient’s bed. Robotic-assisted surgery requires much smaller incisions that help reduce blood loss and speed postoperative recovery times. UC Davis surgeons perform dozens of robotic-assisted prostatectomies each month using the state-of-the-art da Vinci® computer-enhanced surgery system.
It is similar to the conventional, minimally invasive laparoscopic prostatectomy. However, working from a special console in the operating room, the surgeon operates four precision-guided robotic arms to cut and remove the prostate. The procedure uses a small video camera, inserted through a keyhole-sized incision to provide surgeons with magnified, 3-D images of the prostate site. This expansive view allows doctors to see the nerve bundles and muscles surrounding the prostate. The robotic arms, with full 360-degree rotation capabilities, are placed through several other keyhole incisions allowing surgical instruments to move with greater precision, flexibility and range of motion than in a standard laparoscopy.
The procedure usually takes 2 to 3 hours under general anesthesia. Most patients experience only a small blood loss and blood transfusions are needed in less than one percent of patients. Prostatectomy patients typically spend one night in the hospital and are usually discharged as soon as their laboratory tests are acceptable, pain is controlled and they are able to retain liquids. Patients are discharged with special catheter, which is removed during an outpatient visit 5-7 days after the operation.
The surgery usually includes removing the prostate, seminal vesicles and ends of the vas deferens. For intermediate and high-risk patients, the pelvic lymph nodes are also removed. Patients typically experience significantly less pain and less blood loss than those undergoing conventional “open incision” procedures. Patients also tend to enjoy quicker recovery times. A traditional, open radical prostatectomy requires two days hospitalization and recovery lasting about 2 months. With robotic-assisted surgery, the recovery time is as little as 2-3 weeks. Depending on age and health, most patients can also expect to have their potency return with or without the use of oral medications.
The decision to surgically treat prostate cancer involves many considerations. UC Davis’ urologic surgeons will discuss your treatment options and help you decide the best course of action. Nearly all patients diagnosed with localized prostate cancer will have the option of choosing robotic-assisted surgery. It is the now most commonly selected prostatectomy approach in the United States. Patients with significant abdominal adhesions or obesity, however, may not be appropriate candidates for the this procedure.
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.
As with any major surgery done under general anesthesia, there is a certain amount of risk, including heart attack, stroke and death. Preoperative assessment of a patient’s overall health is part of the surgical workup at UC Davis. Prostatectomies, including those done with a robotic-assisted surgery system, are also associated with the risks of impotence and incontinence.
Urinary continence depends on the internal, involuntary sphincter and the voluntary striated external sphincter. The internal sphincter is removed during all forms of prostatectomy, as it is anatomically at the junction of the prostate and bladder. Performing specialized Kegel exercises after surgery to strengthen muscles enables patients to control their external sphincter and gain continence (dryness). This takes several weeks to several months. Overall, significant urinary leakage occurs in only 0.5 percent of UC Davis patients. About 15 percent of patients report mild stress incontinence.
Return of normal erectile function depends on a number of physical and psychological factors, including the type of prostatectomy (unilateral or bilateral; nerve-sparing or non-nerve sparing, etc.). Function may return from one week to one year after surgery, It typically takes several months. A program of “penile rehabilitation,” using medications such as Viagra or Muse, is recommended as part of the process to facilitate healing and return of erectile function. Additional factors that can affect erectile function include hypertension, diabetes, obesity, atherosclerosis, smoking and anxiety.
What about long-term follow-up from robotic-assisted prostatectomy?
As with any case of cancer, monitoring for recurrence is crucial. Patients may or may not need additional cancer treatments, depending on the pathology report following surgery. Your physician will develop a post-operative action plan for you, which would likely include periodic measurement of blood PSA, which is still considered best indicator of cancer recurrence.