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How Is The Prostate Removed In Robotic Surgery

Transurethral Resection Of The Prostate

Robotic Prostate Surgery – The Nebraska Medical Center

This operation is more often used to treat men with non-cancerous enlargement of the prostate called benign prostatic hyperplasia . But it is also sometimes used in men with advanced prostate cancer to help relieve symptoms, such as trouble urinating.

During this operation, the surgeon removes the inner part of the prostate gland that surrounds the urethra . The skin is not cut with this surgery. An instrument called a resectoscope is passed through the tip of the penis into the urethra to the level of the prostate. Once it is in place, either electricity is passed through a wire to heat it or a laser is used to cut or vaporize the tissue. Spinal anesthesia or general anesthesia is used.

The operation usually takes about an hour. After surgery, a catheter is inserted through the penis and into the bladder. It remains in place for about a day to help urine drain while the prostate heals. You can usually leave the hospital after 1 to 2 days and return to normal activities in 1 to 2 weeks.

You will probably have some blood in your urine after surgery.

Other possible side effects from TURP include infection and any risks that come with the type of anesthesia used.

* Minimal Blood Loss With Da Vinci Robotic

The average estimated blood loss per patient averages 116 cc. This volume is roughly the 1/3 of the volume of a 12 oz. soda can. Estimated Blood loss has ranged for robotic patients from 25cc to a maximum of 400 cc in the 1st 100 patients. Because of these low blood losses, none of these men required a blood transfusion, nor were they asked to donate autologous blood prior to surgery.

The Steps Of The Robotic Surgery:

Robotic surgery is really a remote control operation, where the surgeon sits at a real distance from the patient and as he does the surgery, the entire movements of the surgeon are translated through the sensitive fibers of the machine with certain precision to the tip of the instruments.

  • Keyhole incisions are being made in the patients abdomen
  • Fine robotic instruments are being placed inside the abdomen
  • A 3D endoscope and an imaging device is being placed inside the abdomen for enhanced precision
  • The surgeon operates the console to maneuver the instruments so as to cut and remove the prostate
  • The prostate is being removed through one of the keyholes
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    Surgical Robots Developed By Vanderbilt Researchers Could Make Radical Prostatectomy Safer And Less Invasive

    Media Inquiries

    Researchers at the Vanderbilt Institute for Surgery and Engineering have developed a minuscule robot that could revolutionize surgical procedures for treating prostate cancer, which affects one in nine men in the United States. Using a lifelike model, the team demonstrated that the surgical robot could not only remove the prostate gland and tissues through the urethra, but also accomplish the difficult step of suturing the bladder to the urethra.

    The article describing their research, Transurethral Anastomosis After Transurethral Radical Prostatectomy: A Phantom Study on Intraluminal Suturing With Concentric Tube Robots, was in the journal Institute of Electrical and Electronics Engineers on Oct. 29.

    A typical radical prostatectomy, which is the standard treatment for prostate cancer, requires cutting through the abdomen to reach the prostate. This cutting and exposure of healthy tissue and nerves can cause incontinence and erectile dysfunction in some who undergo the procedure. There are no current alternative endoscopic removal techniques because there are no available instruments that allow surgical dexterity at such a small scale.

    The research was funded by the NIH grant R01 EB026901.

    Figure 2 Practice Makes Perfect

    da Vinci Robotic Prostatectomy  Ricardo Gonzalez, M.D.

    The likelihood that a surgeon performing laparoscopic prostatectomy will have to switch to open abdominal surgery in order to complete the operation goes down significantly with practice, measured in the number of operations performed.

    Source: Journal of Urology, July 2005.

    Did he mention anything about the visualization of the neurovascular bundles?

    Yes, he felt pretty confident that with the increased magnification, he would be able to move them aside, and remove the prostate with no problem. He said, If the cancer has spread into the seminal vesicles, then obviously we have to deal with that. And we wont know until the operation. But he seemed pretty confident that after the operation Id be in good shape.

    Did you consider having robotic surgery closer to home?

    You know, I did look into it. But I did some research, and it looked like there werent many people doing this at the time in the city where I live, and they didnt have a lot of experience. One surgeon had done 50 of these operations. The doctor I met with had done about 400. So Im thinking, Okay, 50 versus 400. I think Ill go with the guy whos done 400.

    What kind of logistics were necessary, with you being in one city and the operation being done in another?

    There were some logistical challenges. I ended up doing the preoperative testing at a hospital near my home, and then had it sent to the surgeon in the other city. He was willing to accept their medical tests.

    How long did you have it in place?

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    * Better Prostate Cancer Control

    The true color 3-D high magnification vision, ‘intuitive’ manipulation of technologically advanced, precisely articulated surgical instruments, and better control of blood loss results in better visibility and precision allowing the surgeon to more carefully identify, expose, and dissect out cancerous prostate. The overall rate of margin positivity of robotic prostatectomy is < 19%. More importantly, in men whose cancer is confined to within the prostate, the apical region was correctly visualized and dissected, resulting in very low 6% positive margins in cases of organ confined disease. Prior to the Da Vinci robot, it was very difficult to make such a clean and refined excision of the apical region of the prostate.

    What Are The Potential Risks And Complications Of Robotic Prostatectomy

    The risks of robotic prostatectomy are much the same as those of open surgery. There are general risks associated with all types of surgery, such as the risks of Anaesthetic problems / complications which occur rarely e.g.:

    • Cardiac complications such as a heart attack, arrhythmia, etc.
    • Stroke.
    • Major bleeding requiring blood transfusion or re-operation to stop bleeding â please inform Dr Nathan, the anaesthetist and the hospital staff if you do not wish to receive blood products .
    • Blood clots developing in the legs and/or lungs .
    • Very rarely death as a result of major surgery .
    • Pressure effects as a result of immobilisation during surgery causing symptoms such as pain or bruising, or damage to nerves, which may lead to transient or permanent numbness, tingling or muscle weakness.

    Specifically, with robotic radical prostatectomy there are risks of:

    It is important to be aware that the majority of these risks are not common, and that most of these with the exception of open conversion are also risks of the open radical prostatectomy.

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    Surgery For Prostate Cancer

    Surgery is a common choice to try to cure prostate cancer if it is not thought to have spread outside the prostate gland.

    The main type of surgery for prostate cancer is a radical prostatectomy. In this operation, the surgeon removes the entire prostate gland plus some of the tissue around it, including the seminal vesicles.

    Open Radical Prostatectomy Vs Minimally Invasive Radical Prostatectomy

    Robotic Assisted Laparoscopic Radical Prostatectomy | Brigham and Women’s Hospital

    In 2003, only 9.2% of radical prostatectomies were done using a minimally invasive procedure. By 2007, that number had jumped to 43.2%. In 2009, researchers in Boston reported on a study that compared outcomes, benefits, and complications of open surgery vs. minimally invasive surgery:

    • No difference was found in deaths or in the need for additional cancer therapy between the two approaches.
    • The median hospital stay was two days for minimally invasive surgery and three days for open surgery.
    • 2.7% of men having laparoscopic surgery required a blood transfusion compared with 20.8% of men having open surgery.
    • There was more anastomotic stricture — narrowing of the suture where internal body parts are rejoined — for open surgery than for minimally invasive surgery .
    • There were fewer respiratory complications with minimally invasive surgery than with open surgery .
    • There were lower rates of incontinence and erectile dysfunction with open surgery. The overall rate was 4.7% for laparoscopic surgery and 2.1% for open surgery.

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    What Is Robotic Prostate Cancer Surgery

    Of the available comprehensive treatment options, UCA is proud to offer robotic prostate cancer surgery to patients with prostate cancer. As a surgical treatment option, the radical prostatectomy procedure removes the entire prostate gland. This can be performed by laparoscopic or robotic techniques. When open prostate surgery is performed, the prostate gland is removed through a larger incision in the lower portion of the abdomen. Laparoscopic prostate surgery involves small incisions, around the size of a keyhole, which are used for inserting a lighted viewing instrument into the pelvic region and allows the surgeon to examine and remove the prostate without a large, cumbersome abdominal incision.

    What Is A Robotic Prostatectomy

    Robotic prostatectomy, or robotic-assisted laparoscopic radical prostatectomy, is the complete surgical removal of the prostate, seminal vesicles, and vas deferens for the treatment of prostate cancer. Compared with the traditional “open” operation, the procedure is performed through small incisions using the daVinci Surgical System.

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    Who Should Undergo Radical Prostatectomy

    Men younger than age 75 with limited prostate cancer who are expected to live at least 10 more years tend to get the most benefit from radical prostatectomy.

    Before performing radical prostatectomy, doctors first try to establish that the prostate cancer has not spread beyond the prostate. The statistical risk of spread can be determined from tables comparing the results of a biopsy and PSA levels. Further testing for spread, if needed, can include CT scans, bone scans, MRI scans, and ultrasound.

    If it appears that the prostate cancer has not spread, a surgeon may first offer other options besides surgery. These can include radiation therapy, hormone therapy, or simply observing the prostate cancer over time, since many prostate cancers grow slowly. Depending on how high the risk of cancer spread, pelvic lymph node dissection may be considered, as well.

    What You Need To Know About Prostate Surgery

    Robotic Prostate Surgery Photograph by Aberration Films ...

    What is prostate surgery for?

    The prostate is a gland located underneath the bladder, in front of the rectum. It plays an important role in the part of the male reproductive system that produces fluids that carry sperm.

    Surgery for partial or complete removal of the prostate is called a prostatectomy. The most common causes for prostate surgery are prostate cancer and an enlarged prostate, or benign prostatic hyperplasia .

    Pretreatment education is the first step to making a decisions about your treatment. All types of prostate surgery can be done with general anesthesia, which puts you to sleep, or spinal anesthesia, which numbs the lower half of your body.

    Your doctor will recommend a type of anesthesia based on your situation.

    The goal of your surgery is to:

    • cure your condition
    • maintain the ability to have erections
    • minimize side effects
    • minimize pain before, during, and after surgery

    Read on to learn more about the types of surgery, risks, and recovery.

    The goal of prostate surgery also depends on your condition. For example, the goal of prostate cancer surgery is to remove cancerous tissue. The goal of BPH surgery is to remove prostate tissue and restore the normal flow of urine.

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    Surgery For Prostate Cancer : Introduction

    With prostate cancer, when conditions warrant, it can become necessary to completely remove the prostate gland in order to reduce the chance of the cancer spreading further. In surgery for prostate cancer, this is known as a radical prostatectomy. While the prostate serves an accessory role in ejaculation and aides in stemming the flow of urine , it is not essential and can generally be removed with only minor effect on patient quality of life, while greatly increasing patient longevity.

    Radical prostatectomy has been performed as an open surgery for quite some time with good success, however as minimally invasive surgery has evolved, it has become possible to perform radical prostatectomies laparoscopically. Recent leaps in technology with the advent of Intuitive Surgical Inc.’s da Vinci robot have taken radical prostatectomy past laparoscopy to an all new level of success. In the hands of a skilled surgeon like Dr. Ahlering, of UC Irvine Medical in Orange County, this new tool allows the radical prostatectomy to be performed minimally invasively with greater precision and ease to both the patient and the surgeon than ever before.

    What Happens During Surgery

    Your surgeon will put a small needle just below your belly button, into your abdominal cavity. The needle is connected to a small tube that passes carbon dioxide into the belly. This lifts the abdominal wall to give the surgeon a better view once the laparoscope is in place.

    Next, a small cut will be made near your belly button. The laparoscope is placed through this incision and is connected to a video camera. The image your surgeon sees in the laparoscope is projected onto video monitors placed near the operating table.

    Before the surgery, the surgeon will take a thorough look at your abdominal cavity to make sure the laparoscopy procedure will be safe for you. If the surgeon sees scar tissue, infection, or abdominal disease, the procedure will not be continued.

    If the surgeon decides the surgery can be safely performed, more small cuts will be made, giving them access to the abdominal cavity. If necessary, one of these small incisions may be enlarged to remove the pelvic lymph nodes.

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    The Prostate Cancer Outcomes Study

    This study involved 1,291 men ages 3979 who filled out questionnaires asking about specific changes in urinary and sexual functioning following radical prostatectomy. When questioned 18 months or longer after treatment, 8.4% of men reported being incontinent, and 59.9% reported being impotent. These percentages indicate incontinence and impotence may be more common than other studies, which relied on patients volunteering specific information, have found.

    Source: Stanford JL, Feng Z, Hamilton AS, et al. Urinary and Sexual Function after Radical Prostatectomy for Clinically Localized Prostate Cancer: The Prostate Cancer Outcomes Study. Journal of the American Medical Association 2000 283:354-60. PMID: 10647798.

    And what did the radiation oncologists advise?

    I was really impressed with both men. They talked about the implantation of radioactive seeds . I said to one of them, You know, Im getting all this information and Im in overload here. So if you were in my position, what would you do?

    And he said, Well, Im 20 years younger than you. So if I had prostate cancer, I would have surgery. Because Im most concerned about living a long life.

    And I said to myself, Look, pal, I want to live a long life too!

    Did he provide evidence that surgery would make an individual patient live longer?

    Did either of the radiation oncologists mention external beam radiation?

    So then what happened?

    Have you talked with him since then? Has there been any improvement?

    What impressed you?

    What Is The Difference Between Robotic And Laparoscopic Radical Prostatectomy

    Robot-assisted radical prostatectomy robot-assisted surgical removal of the prostate

    Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeon’s sophisticated maneuvers.

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    What Are The Side Effects

    Medical research shows that symptoms of incontinence and impotence are similar for both minimally invasive surgery and traditional surgery. Men usually return to normal urinary function within 3 months.

    Because this technique is nerve-sparing, a man’s postoperative ability to have an erection should be comparable to that of traditional surgery. Recent studies have shown no difference between laparoscopic surgery and open surgery called open radical prostatecomy .

    Types Of Radical Prostatectomy

    The prostate gland lies just under the bladder, in front of the rectum. Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.

    Open prostatectomy

    In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and anus.

    Laparoscopic prostatectomy

    In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.

    Robot-assisted laparoscopic prostatectomy

    Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.

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    How Will Prostate Surgery Affect My Sex Life

    Experienced robotic surgeons like Dr. David Samadi dont open the endopelvic fascia during surgery, which spares the rick of damage to nerve bundles that control sexual function. The recovery of the function, however, is not immediate and you should not feel discouraged if weeks or even a few months after surgery you experience erectile dysfunction. It is not an indication of long-term damage.

    One major change that you will notice in your sex life is the absence of sperm. Having no prostate, the body will not produce semen during the orgasm. The sperm cells will be simply reabsorbed by the body them. This is not harmful and you shouldnt be worried about it. Plenty of men deal with the problem with the help of medication that improves erectile dysfunction.


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