How Is Robotic Prostatectomy Performed
The surgeon sits at a console a few feet from the patient and operates the computerized controls. A camera and specialized instruments are mounted on the robotic arms, which are inserted through four small incisions in the patient’s abdomen and connected to the robot.
As the surgeon moves his or her hands, wrists and fingers, the robotic technology translates the motions into precise micro-movements that allow greater precision — especially critical to spare nearby nerves that control urinary continence and sexual function.
Following the surgery, patients are monitored overnight and usually go home the next day. A urinary catheter remains in place for about a week. Most patients return to normal activities in two to three weeks.
What Are The Patient Criteria For Robotic
The decision to surgically treat prostate cancer involves many considerations. UC Davis urologic surgeons will discuss your treatment options and help you decide the best course of action. Nearly all patients diagnosed with localized prostate cancer will have the option of choosing robotic-assisted surgery. It is the now most commonly selected prostatectomy approach in the United States. Patients with significant abdominal adhesions or obesity, however, may not be appropriate candidates for the this procedure.
Robotic Urologic Surgery Complications
Erdem Koc Abdullah Erdem Canda
Department of Urology, Ankara Ataturk Training and Research Hospital, Ankara 06800, Turkey.
Correspondence Address: Dr. Erdem Koc, Department of Urology, Ankara Atatürk Training and Research Hospital, Bilkent ST, No.1, Çankaya, Ankara 06800, Turkey. E-mail: [email protected]
Received: First Decision: Revised: Accepted: Science Editor: Copy Editor: Production Editor:
© The Author 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License , which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author and the source, provide a link to the Creative Commons license, and indicate if changes were made.
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Robotic Surgery For Benign Prostatic Hypertrophy
At Temple Health, we offer robotic surgery to treat men with benign prostatic hypertrophy who have a severely enlarged prostate.
Many men with an enlarged prostate caused by BPH can be treated with medications to shrink the gland or improve urine flow and bladder emptying. When men have worsening urinary obstructive symptoms due to prostatic enlargement that failed medical therapy, they may be candidates to undergo a transurethral surgical procedure to alleviate their obstruction and improve the urinary symptoms. Procedures such as Transurethral Resection of Prostate and Urolift are examples of effective surgical procedures to help remove or destroy the obstructing prostate tissue and create a wider channel.
What Are The Side Effects Of This Procedure
There are several possible side-effects after prostatectomy, and many of them will depend on a patient’s individual characteristics. The most common side effects are incontinence, impotence, and discomfort. A bladder catheter will be placed at the time of surgery and is generally removed one week later. Incontinence of varying degrees will be initially experienced by most patients, but should improve over time. The majority will be continent within 3-6 months.
Impotence can also occur. Risk factors for impotence include age and pre-operative erectile dysfunction. Patients who are candidates for nerve-sparing surgery and who do recover their erections may do so within a few weeks to up to two years.
Probably the number one complaint after this surgery is pain in the perineum , which can occur in about 10% of patients. This can last for a month or so, but usually responds well to Ibuprofen.
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Caring For The Catheter
You will be discharged with a Foley catheter, a tube that continuously drains urine from your bladder into a bag and that you will use for seven to 10 days. Before you leave the hospital, your nurse will teach you how to empty and care for your catheter and drainage bag. The catheter works with gravity and should be draining urine at all times, so you have to keep the drainage bag below your bladder at all times, even when you shower. If your urine is not draining, lower the bag and check the connection for kinks or loops. Loops can cause an air lock that prevents drainage. You can also try emptying the bag. Then try briefly disconnecting the catheter from the clear plastic tubing to allow a little air into the system. Your nurse will show you how to do this before your discharge.
To prevent infection, you must keep your catheter clean. This section explains how to clean the catheter, the area around the catheter and the drainage bag. It also explains how to apply your leg bag and secure the catheter to your leg.
We will provide most of the supplies you need to care for your catheter. They include:
- StatLock Foley catheter securement device
- Shaving supplies
You should empty the catheter bag when its half full. This helps prevent air locks from developing in the tubing.
To apply the leg bag:
How Long Has Cleveland Clinic Been Performing Laparoscopic Prostatectomies
Cleveland Clinic was the first in the United States to establish laparoscopic prostatectomy program in 1997 and routinely offer this procedure to patients. Our specialists have been performing robotic prostate surgery for the past 5-6 years.
Robotic and Laparoscopic Surgery Offer Advantages in Treatment of Prostate Cancer
Cleveland Clinic was the nation’s first medical center to routinely perform laparoscopic prostate surgery and amongst the first to perform robotic radical prostatectomy. Now laparoscopic and robotic surgery is enabling surgeons to perform this complex minimally invasive surgery with more precision, offering patients improved outcomes. Cleveland Clinic uses the state-of-the-art robotic surgical system that has been approved by the FDA for use in performing many surgical procedures, including radical prostatectomies, general laparoscopic surgery, thoracoscopic surgery, and thoracoscopically-assisted heart procedures.
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Am I Too Old To Have Prostate Surgery
How old is too old to have a radical prostatectomy?
William D. DeWolf, M.D., Chief of the Division of Urology at Beth Israel Deaconess Medical Center, says:
For surgery to make sense that is, for the benefits to outweigh the risks you need to be young enough to take advantage of the added survival time that surgery can offer. Thats why I generally dont recommend this surgery for a man whose life expectancy is less than 10 years, or for a man who is older than 75, depending on his personal and family health history.
Radical prostatectomy is a major operation that can cause serious and life-threatening complications such as blood clots in the legs and lungs, abnormal heart rhythms, heart attack, pneumonia, and infections. The risk increases in older men and in those with other medical conditions, such as heart and lung disease, high blood pressure, diabetes, or a history of blood clots. Some studies have shown that side effects, namely urinary incontinence and erectile dysfunction, also increase with age.
Benefits Of Using Robotic Surgeons For Prostate Cancer
Robotic prostate cancer surgeon help is taken nowadays in the hospital. There are many reasons for it. One of the most significant and common reasons is that it provides the people with a lot of benefits during the surgery, which is helpful. Here are some benefits among them-
With the help of robotic surgery for prostate cancer, the doctor will take significantly fewer days for the accomplishment of your surgery. It means that you can go back to your home sooner.
If your surgery is done by taking the help of robotic surgeons, you will have less blood loss and also less transfusion.
One of the most significant benefits that you can enjoy by taking the help of doctors who uses robotic surgeons for prostate cancer is that you will have smaller incisions as well as less scarring during the surgery.
The robotic surgery for prostate cancer allows you to have improved cancer control as well as promises you to have a faster return to the convenience and the potency.
If the doctor uses the robotic surgeons, they will be able to have more successful treatments or surgeries than before and can more patent life.
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Why Are Robotic Surgeries Better Than Traditional Open Surgeries For Prostate Cancer
In the present time, you can see that robotic prostate cancer surgeon help is taken in the hospital rather than the traditional open surgeries.
There are many reasons for it. One of the most common reasons for using robotic surgeons for prostate cancer than the traditional open surgeries is that there is more surgery done by doctors with the help of robots are more perfect.
Here are some more reasons for using robotic surgeons rather than traditional open surgeries:
Hospitals take the help of robotic surgeons because the robots can help the doctors to complete the surgery within the time without any mistake.
With the help of robotic surgeons or robots, doctors can complete the surgery correctly.
They are more preferred than the traditional open surgeries for prostate cancer because the outcome of the surgery done by doctors with its help is always impressive and helps the patient to recover fast.
Robotic surgeons are mainly Hi-Tech robots which can help the doctors to work more flexibly and better access to internal organs of the patients body.
If the doctors use the robotic surgeon, there will be less chance of making a mistake.
According to other research, robotic surgeons are much better for the surgery of prostate cancer than traditional open surgeries.
Mri Screening For Prostate Cancer
The prostate non-contrast MRI is the most dependable device for screening and detecting the 15 percent or so of potentially deadly high-grade prostate cancers. Unlike the current standard screening and detection methods, the 3T MRI evaluates the WHOLE of the prostate, can ignore the bogus G6 cancer and, based upon imaging details in a properly conducted study, able to identify reliably with PIRADS 4 and 5 features, almost all high-grade cancer anywhere within the prostate a feature which makes the MRI an ideal surveillance tool to monitor existing low-risk 3+4 cancers or, for detection of possible field-change effects and the uncommon development of a higher grade cancer at some future time. Any high-grade areas identified can then be targeted for needle biopsy under real-time 3T MRI for pathological confirmation as only these particular prostate cancers demand detection and treatment commonly now, with MRI-guided focal therapy.
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Bleeding After Prostate Surgery
Bleeding after prostate surgery is among the most common problems. To prevent the problem, a drain system is installed in the surgical area, and in addition to this system, some treatments are also performed to prevent bleeding. Although bleeding after prostate surgery is not a sign of important problems, you should definitely contact your physician if the condition has become chronic.
There is a number of risks that can occur after prostate surgery. These risks may include urination problems, urinary incontinence, bleeding, and sexual dysfunction. In this article, we will talk about the bleeding problem faced after prostate surgery.
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Who Needs A Prostatectomy
Prostate cancer is usually a slow growing cancer. If you have this type of prostate cancer, you and your doctor may decide to watch the cancer by doing blood tests, prostate exams, and prostate biopsy. In many cases, surgery is never needed.
Some prostate cancers grow quickly. These cancers can cause death if not treated. In fact, prostate cancer is the second leading cause of cancer deaths in men. Cancers that grow quickly are called aggressive. When you have a biopsy to diagnose prostate cancer, the cells will be examined and given a score for aggressiveness. This is called a Gleason score. A Gleason score less than 6 is a slow growing cancer. A score of seven is in the middle, and a score of 8 to 10 is aggressive. Prostatectomy may be the best treatment for an aggressive cancer.
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Equipment For Laparoscopic Radical Prostatectomy
The laparoscopic approach involves 2-dimensional monitors and conventional laparoscopic instruments with a 10-mm 0° and/or 30° telescope. The camera may be operated by a one-armed camera holder or by an assistant. The use of a single voice-operated robotic arm has also been described as an adjunct to the laparoscopic approach. A camera-holding device provides stability and prevents camera shake that can result from holding it by hand .
What Sexual Side Effects Are Possible After Robotic And Laparoscopic Prostate Surgery
Laparoscopic and robotic prostate surgery are highly precise in their ability to spare the nerve bundle responsible for erections. The degree of sexual function after radical prostatectomy is determined by many factors. These include the man’s age, how sexually active he was before the procedure. Most men experience at least temporary erectile problems after a radical prostatectomy. Our recently demonstrated 82% potency rate at 1 year following “energy-free” laparoscopic radical prostatectomy in patients with excellent preoperative erections is amongst the best in the literature.
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Different Types Of Radical Prostatectomy
There are various types of radical prostatectomy.
- Radical prostatectomy with the retropubic approach
This is the most common type of radical surgery performed by most urologists. By means of this procedure, the surgeon can even remove the lymph nodes if they are also affected by prostate cancer.
If cancer has spread into the nervous area, there may be fewer chances to spare the nerves that are related to erection production. In this case, the surgeon may need to cut the nerves on both sides of the prostate, thus losing the erectile function. But if cancer has not spread to the nerves, then the erectile function may come back to normal in a short while.
- Radical prostatectomy with the perineal approach
Radical prostatectomy with the perineal approach is used less often than the prostatectomy with the retropubic approach. By using this surgical technique, the nerves can not be spared. Also, the lymph nodes can not be removed. However, the advantage of this procedure is that is less time-consuming. Also, it is recommended for men who may not benefit any more from nerve-sparing. Al factors need to be taken into account, as the perineal approach is more painful and esthetically not so good looking.
- Laparoscopic radical prostatectomy
Laparoscopic radical prostatectomy involves several small incisions through which small instruments are being introduced with a video camera inside.
- Robotic radical prostatectomy
Is Robotic Surgery Safe For Prostate Removal
When considering surgical treatment options, patients often have concerns about safety. When specifically considering robotic surgery for prostate removal and other procedures, some patients wonder if da Vinci Surgery is as safe as traditional surgery.
Actually, minimally invasive robotic procedures performed with the da Vinci System can be considered safer than traditional surgery because it offers multiple, redundant safety features making it the most effective, least invasive surgery possible. During the course of an operation, the da Vinci System will perform millions of safety self checks. The da Vinci System is so safe and precise that it has been used successfully in tens of thousands of minimally invasive surgeries worldwide. The ability to perform robotic surgery has significantly impacted the surgical capabilities of urologists and gynecologists in particular.
The da Vinci System cannot be programmed nor can it be controlled or make decisions on its own. Every surgical maneuver is performed with the direct input from Dr. Allen who is just a few feet away using the console controls. The da Vinci Surgical System senses, scales, filters, and translates his wrist and finger movements to create a precise movement with the miniaturized instruments. The tremor reduction feature even minimizes unintended movements. Therefore, da Vinci robotic surgery is even more precise than Dr. Allens own hand!
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Questions To Ask Your Doctor Or Nurse
You may find it helpful to keep a note of any questions you have to take to your next appointment.
- What type of surgery do you recommend for me and why?
- What type of surgery do you recommend for me? Will you try to do nerve-sparing surgery?
- How many of these operations have you done and how many do you do each year?
- Can I see the results of radical prostatectomies youve carried out?
- What pain relief will I get after the operation?
- How and when will we know whether the operation has removed all of the cancer?
- How often will my PSA level be checked?
- What is the chance of needing further treatment after surgery?
- What is the risk of having urinary problems or erection problems and what support can you offer me?
What To Expect From Minimally Invasive Da Vinci Robotic Surgery
The da Vinci System is a sophisticated robotic platform that offers a minimally invasive option for major surgery. Urologists such as Dr. Allen use this system to perform radical prostate removal in cancer patients, as well as other urologic surgeries. The da Vinci Surgical System cannot be programmed nor make decisions on its own. The system is controlled by a skilled and trained surgeon and every surgical maneuver is performed by direct input from that surgeon.
Like with laparoscopic surgery, with da Vinci robotic surgery, tiny incisions are used instead of the traditional large incision. These tiny incisions allow miniaturized wristed instruments and a high-definition 3D camera into the body cavity. Your surgeon will be seated comfortably at the da Vinci console while viewing live, magnified, high-resolution 3D images of the bodys interior. Simultaneously, state-of-the-art robotic and computer technologies scale, filter, and seamlessly translate your surgeons hand movements into precise micro-movements. This is the only technology available in the medical field with the precision, dexterity and control of traditional open surgery, while only requiring dime-sized incisions.
- Enhanced 3D view of the operating area
- Reproducibility
- Reduced trauma to the patient
- Shorter hospital stay
- Less pain following the operation
- Faster and more complete recovery
- Quicker return to normal daily activities
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