What is a robotic prostatectomy?
A robotically assisted laparoscopic radical prostatectomy utilizes the da Vinci™ Surgical System(©2006 Intuitive Surgical, Inc.). The da Vinci™ System is a computer enhanced, minimally invasive surgical tool controlled by the surgeon.
The patient side cart sits at the bedside and holds the 4 robotic arms. The console is an ergonomically designed device that allows the surgeon’s movements to be translated into action utilizing the robotic arms. The robotic arms utilize EndoWrist™ instruments that have more degrees of freedom and precision than the human wrist.
The da Vinci™ Surgical System(©2006 Intuitive Surgical, Inc.) is the first operative surgical robot approved for surgical use by the Food and Drug Administration.
How is robotic prostatectomy performed?
A robotic prostatectomy is performed through small laparoscopic ports. Typically, five ½ to 1 inch keyhole incisions are made in the abdomen for introduction of the laparoscopic ports. The traditional surgical approach uses a larger incision from just below the umbilicus to the pubic bone. The abdomen is inflated with carbon dioxide gas to create a surgical working space. The surgeon operating the robot controls the camera and 3 separate mechanical arms inserted through the laparoscopic ports. The surgeon at the bedside works through the 5th port providing exposure and introducing and removing suture and surgical clips.
The surgical team then removes the lymph nodes and the prostate and reconstructs the urinary tract in a manner similar to the traditional open approach.
Why perform the robotic prostatectomy?
The traditional open prostatectomy was associated with significant morbidity in years past. High volumes of blood loss, significant pain for the patient, long hospital stays, high rates of urinary incontinence (urine leakage) and high rates of erectile dysfunction used to be the norm. Advances in surgical technique and a better understanding of anatomy have decreased these risks into a more acceptable range.
The robotic prostatectomy may be the most important technologic advance in the surgical treatment of prostate cancer. The advantages of the robotic system combined with proven surgical techniques aim to achieve even better patient results.
How can the robotic prostatectomy improve these results?
The da Vinci™ Surgical System (©2006 Intuitive Surgical, Inc.) offers improved visualization, magnification and surgical precision over open surgery. The specially designed InSite™ Vision System offers magnification and a 3-D visualization of vital anatomy such as blood vessels and nerves. The mechanical arms provide precision and freedom of wrist movement greater than that achieved by traditional laparoscopic instruments and even the human hand. They also act to reduce the fatigue associated with long procedures and eliminate tremor.
These advances should allow the surgeon to separate critical nerves, blood vessels and muscles from the prostate to improve the side effects of erectile dysfunction and incontinence while reducing blood loss and still completely removing the cancer. The smaller incisions may reduce post-operative pain, reduce scarring, shorten the hospital stay and lead to faster recovery and return to normal activity.
What can I expect after surgery?
Patients can expect a 1 or 2 night hospital stay in single-patient hospital rooms where a family member may also stay. A post-operative pathway ensures safe and efficient patient care. Both written and verbal post-operative instructions are provided prior to discharge.
Patients who travel 300-400 miles are safe to ride home once they are discharged, but many choose to stay at a local hotel for 1-2 nights. Patients can typically expect their catheter to remain in for 7-10 days after surgery at which point they will return for removal and a discussion of their pathology report.
What hospitals can UCNT surgeons perform a robotic prostatectomy?
A robotic prostatectomy can be performed at the following hospitals:
- Baylor University Medical Center at Dallas
- Baylor Regional Medical Center at Grapevine
- Baylor Regional Medical Center at Plano
- Texas Health Presbyterian Hospital of Dallas
- Texas Health Presbyterian Hospital of Plano
- Medical City Hospital
Source: Urology Clinics of North Texas and Intuitive Surgical, Inc.