ROBOTIC PROSTATE SURGERY (PROSTATECTOMY): THE NEW NORM?
Prostate cancer is the most common cancer in men and the second leading cause of cancer death among them. Luckily, this cancer is not usually aggressive and does not lead to death in the majority of cases if treated.
There are several surgical techniques to treat prostate cancer. Open (traditional) surgery, laparoscopic surgery, and robotic surgery are valid options. In the past few years, robotic surgery has gained a lot of popularity and became the mainstay of treatment in some centers.
Robotic prostatectomy employs the help of an advanced surgical robot to extract the prostate gland. It helps your surgeon perform the surgery with less effort and more precision.
Keep reading to learn more about how robotic prostate removal works
Prostate Cancer Surgery
Prostate cancer surgery is called radical prostatectomy. It is generally indicated for younger men (<70 years old) whose prostate cancer has not spread to other parts of the body (see below for more details).
There are several techniques to remove the prostate surgically:
- Open radical prostatectomy: This is the traditional prostate removal surgery. An open prostatectomy is done through a large incision in the lower belly (around 10-15 cm long). The prostate is removed along with any surrounding lymph nodes.
- Laparoscopic radical prostatectomy: Laparoscopic radical prostatectomy is a minimally invasive technique to surgically remove the prostate. In this technique, three or four small (1 cm) incisions are made in your abdomen. A camera (laparoscope) is inserted through one hole, and special long surgical instruments are inserted through the others. While looking at the live video feed from the laparoscope, your surgeon will cut out your prostate and take it out.
- Robotic radical prostatectomy: This is a newer minimally invasive prostate removal surgery. It is more advanced than laparoscopic surgery but uses a robot (the da Vinci ® System) to remove the prostate.
Open radical prostatectomy is slowly and steadily fading out of existence, as it was shown to be inferior to minimally invasive techniques.
Minimally invasive techniques (laparoscopic and robotic prostatectomy) have now been adopted by major medical centers as the surgical treatment of choice for prostate cancer. The choice of technique usually depends on your surgeon and what they’re comfortable performing.
Robotic Prostate Surgery vs Traditional Surgery - Which is Better?
Robotic prostate surgery has been being performed since the early 2000s and has since become the surgical treatment of choice for many surgeons.
Compared to traditional (open) prostate surgery, robot-assisted prostatectomy was shown to be associated with fewer surgical risks, less recovery time, less bleeding, less scar formation, and lesser hospital stay. The long-term survival of patients was, however, unchanged.
This means that both robotic and traditional prostate surgery offer the same benefit, but robotic surgery carries fewer risks. This is why urologists were quick to adopt robotic prostatectomy in their practice.
Compared to laparoscopic radical prostatectomy, there does not seem to be a great difference in terms of complications or outcomes. However, according to a recent review, there’s a trend toward better outcomes in robotic prostate surgery.
How is Robotic Prostate Surgery Performed
Robotic prostatectomy is similar to laparoscopic surgery. It is done with the use of an advanced surgery system called the da Vinci ® system.
Like laparoscopic surgery, several keyhole incisions are made in the abdomen to pass a camera and surgical instruments inside.
In laparoscopic surgery, your surgeon will be holding and manipulating the surgical instruments and camera. In robotic-assisted prostatectomy, on the other hand, those will be held and moved around by the robot.
Your surgeon will be sitting at the control unit of the da Vinci ® system to control the robot and remove your prostate with its help.
Once the prostate is removed, your small skin wounds will be sutured and you will be woken up and taken to recovery.
You will have a urinary catheter that will stay for a couple of weeks after your prostatectomy.
Benefits of Robotic Prostatectomy
A systematic review done in 2007 compared robotic prostatectomy and traditional (open) prostatectomy.
Robotic prostatectomy was found to be associated with:
- Less bleeding
- Less hospital stay
- Faster recovery time
- Less postoperative pain
Complications of Robotic Prostate Surgery
Although robotic prostatectomy is associated with fewer risks compared to traditional surgery, it is still not completely risk-free. Occasionally, complications might occur:
- Bleeding: Seen as bloody urine postoperatively. If it doesn’t resolve on its own, further intervention might be necessary.
- Infection: Surgical site infection is a risk with any surgery. It is treated with antibiotics.
- Damage to the bladder or colon: Since the bladder and colon are in close proximity to the prostate, they might be damaged during surgery.
Long Term Side Effects of Prostate Surgery
All types of radical prostatectomy are associated with almost the same risk of long-term side effects. These can include:
- Urinary incontinence: Incontinence can either temporary (up to 1 year) or permanent. Men who develop urinary incontinence after prostate surgery might be candidates for an artificial urinary sphincter.
- Erectile dysfunction: Impotence in men after prostate surgery is not uncommon. This happens as a result of nerve damage during surgery. When possible, your surgeon might implement nerve-sparing surgical techniques during robotic surgery to try and preserve your erectile function.
Robotic prostate surgery is an excellent surgical technique that is rapidly replacing open radical prostatectomy. It offers the same curative outcomes, fewer operative complications, and a speedier recovery. If you’ve been diagnosed with prostate cancer, make sure you ask your urologist about robot-assisted prostate surgery, as it might be one of your options.
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