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If you require treatment for prostate cancer, Community Memorial Hospital’s Cancer Care Center offers a range of treatment options. For surgical options, an experienced, multidisciplinary team of prostate cancer specialists — surgeons, radiation oncologists and medical oncologists — evaluates each patient to determine the best method of surgery and whether follow-up treatment with radiation therapy or chemotherapy is appropriate to attain the best outcome.
Among many options for surgical removal of the prostate gland is the da Vinci® robotic surgical system, an innovative, minimally invasive procedure for prostate removal. Urologists on staff at Community Memorial Hospital who perform robotic-assisted surgery are specially trained.
Traditionally, early-stage prostate cancer has been treated with open surgery, radiation therapy and cryotherapy (freezing the prostate gland). Robotic surgery is the latest advance in surgery to remove the prostate. Similar to open surgical approaches, robotic surgery removes the entire prostate but does so through a series of small incisions. The small incisions, resulting in a shorter post operative recovery, are the main benefit of the robot. In addition, robotic surgery results in less blood loss than open surgery. However, the difference is small. It does not translate into a difference in the need for blood transfusion.
Regarding other important outcome measures, available data suggest potency and continence rates are similar between the two approaches. While early data is very encouraging, longer follow-up with robotic prostatectomy will be needed to determine if cancer control rates are the same as those achieved by open surgery.
The da Vinci® robotic surgical system is designed to help the surgeon see bodily structures clearly and perform surgery precisely. The system offers the surgeon the same dexterity as the human hand by “translating” the surgeon’s hand movements into the precise movements of the robot’s micro-instruments. The precise movements of the robot are important when trying to avoid the nerves that control urinary and sexual functions.
The system’s magnification and 3-D visualization work together to enhance the surgeon’s viewing of the prostate, nerves, bladder and surrounding structures. This allows the surgeon to remove the prostate and nearby areas of concern, while sparing structures that may negatively impact urinary control and sexual function.
Robotic-assisted prostate removal (laparoscopic radical prostatectomy) is a minimally invasive procedure, with the following advantages:
During the robotic procedure, a patient is placed under general anesthesia and positioned on his back. The surgeon makes six small incisions — from ¼-inch to ½-inch long — in the patient’s abdomen.
Hollow cylinders called ports are placed in the incisions, and an operating telescope, camera and surgical instruments are inserted through the ports and into the abdomen. The robot is then positioned at the operating table, and the robotic arms and camera are connected to some of the ports. The surgeon sits at the console a few feet away from the patient, controlling the robotic arms and camera. The surgeon views the surgical area through 3-D goggles, which provide fine details of the body structures.
Once the prostate has been detached from surrounding structures and the urethra (urine tube) has been reattached to the bladder, the robotic arms are removed from the patient. The incision near the navel is enlarged so the entire prostate gland can be removed at once. This is important so that the pathologist can accurately determine the stage of the cancer. All of the instruments are removed, and a temporary urinary catheter and abdominal drain are left in place before the patient is awakened from anesthesia.
The da Vinci® system is designed to maximize surgical outcomes for:
However, no surgical treatment is 100 percent without risk. While all precautions are taken to minimize surgical risks, this procedure does have risks. These include bleeding requiring blood transfusion, infection, urinary incontinence, erectile dysfunction, port-site hernia and injury to adjacent organs.
After surgery, patients usually spend one or two days in the hospital. During the first day, the patient recovers from the anesthetic and receives intravenous (IV) pain medication. By the next day, oral pain medication is usually sufficient. Once pain is under control and bowel function begins to return, patients are ready for discharge.
Patients are discharged home with the urinary catheter, which usually remains in place for about one week. Patients then return to their urologist to ensure adequate healing has occurred and the catheter can be removed. During this time, patients are encouraged to walk often. They may shower, but should avoid swimming or sitting in a bathtub. If the cystogram reveals adequate healing, the catheter is removed.
Once the catheter is removed, urinary control returns after varying lengths of time. Patients are encouraged to initially wear an absorbent pad for protection while they work to retrain the muscles involved in urinary control. Kegel exercises, which strengthen the muscles supporting the urethra, bladder and rectum, are quite helpful. Heavy lifting should be avoided for about four weeks to avoid a hernia forming at the incision sites as they heal.
At the time of the catheter removal, the pathology report concerning the stage of the cancer is shared with the patient. While follow-up treatment will be based on the report results, most patients only need to have the PSA level checked on a regular basis. The first follow-up PSA should be checked three months after surgery and then every six months for the immediate future.
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