The prostate is a walnut-sized gland located in front of the rectum, below the bladder and surrounding the urethra. Its main purpose is to produce fluid that transports sperm during the male orgasm. According to recent estimates, there are 180,000 to 200,000 newly diagnosed cases of prostate cancer detected annually. Prostate cancer is the second leading cause of cancer death in men after lung cancer. In the U.S., approximately 40,000 men die as the result of prostate cancer each year. Prostate cancer is characterized by the uncontrolled growth and potential spread of abnormal cells.
There are three surgical options to remove the entire prostate gland. These options are for patients with early diagnosed organ-confined prostate cancer.
This procedure is also called da Vinci robotic prostatectomy. It is a minimally invasive surgical removal of the prostate involving the latest advancements in robotics and computer technology.
It is a computer-enhanced minimally invasive surgical system consisting of three components:
The Surgeon Console consists of the master controls the surgeon uses in order to manipulate the Patient-side Cart and the EndoWrist instruments. The surgeon’s hand movements are translated to the EndoWrists through the surgeon console. The instruments only move if the surgeon decides to move them. The robot is not in control of the instruments — the surgeon is.
The Insite Vision System provides a 3-D view of the surgical field – a vast improvement over the 2-D view of laparoscopic surgery. This translates to a much better visual field and better depth perception. The high definition video cameras give a 10X to 15X magnification – a view the surgeon could never get with traditional surgery. This is particularly important in visualization of the prostate capsule, sparing the neurovascular bundles responsible for erectile function and reconnecting the urethra to the bladder.
Men who are diagnosed with a localized prostate cancer are candidates for this procedure. Most patients who are candidates for open surgery would have an excellent outcome with this procedure. The indications for this surgery are very similar to open surgery.
Absolutely not! The robot is completely under the control of the surgeon. The robotic arms enable the surgeon to operate in small spaces in the abdomen.
Only once in the past three years has that happened to Dr. Samadi. He was able to complete the case laparoscopically without needing to open the patient’s abdomen. For this reason, it is important to be skilled in open, laparoscopic and robotic surgery.
The catheter is removed seven days after the surgery.
Typically it takes 2½ to 3 hours depending on the size of the prostate, the patient’s anatomy and constitution, and the extent of surgery. This is comparable to the average time of open surgery.
Laparoscopic radical prostatectomy is a minimally invasive surgical treatment for prostate cancer. It involves a few key hole incisions in order to remove the entire prostate.
Radical retropubic prostatectomy is the surgical removal of prostate, seminal vesicles and vas deferens through a lower abdominal incision. The incision measures 8 to 10 inches in length.
The results of cancer control in both laparoscopic and open radical prostatectomy patients is essentially identical. This is confirmed in major institutions across the country where this procedure is being performed on a routine basis.
The majority of patients are discharged the day after surgery. However, the time of discharge is decided on a case-by-case basis. By the second night, over 90 percent of patients are comfortable enough to go home.
For open surgery, the catheter is removed aftertwo to three weeks. However, with a laparoscopic prostatectomy, the catheter is removed seven days after the operation. This is done in our office guided by X-ray to ensure the urethra is properly connected to the bladder.
The average blood loss for this procedure is about 150cc, significantly reducing the risk of blood transfusion.
Every effort is made to spare the nerves. One of the main advantages of this procedure is the fact that the nerves and vessels are all magnified and it is much easier to save them. Return of potency could take up to six months and, in some individual cases, Viagra has helped the patients.
For the first few weeks, one needs to wear a protective pad. The return of continence is fast and, within a few weeks, over 95 percent of the patients have full control of their urination. An occasional patient exhibitsmild stress urinary incontinence after surgery which is usually resolved by performing Kegel exercises.