HomeCancerProstate Cancer Laparoscopic Radical Prostatectomy

Prostate Cancer Laparoscopic Radical Prostatectomy

Radical Prostatectomy Cost In India

Robotic Assisted Laparoscopic Radical Prostatectomy | Brigham and Women’s Hospital
Oncology and Oncosurgery
Radical Prostatectomy Cost in India

Prostate cancer that has not been spread outside of the prostate gland is treated by radical prostatectomy. Radical prostatectomy can be open surgery or it could also be laparoscopic radical prostatectomy surgery, which can be assisted by a robot. Though complete recovery may take weeks or months, modest activity and medicine can assist in the healing process. After a prostate cancer diagnosis, a surgery of radical prostatectomy in India is done to remove the prostate gland and seminal vesicles . Patients with localized prostate cancer may benefit from it as a therapy option. Candidates for the procedure should be in good health and have a 10-year life expectancy.

Radical prostatectomy cost in India depends on the hospital, the doctors experience, and a variety of other factors, this cost may be lower or higher.

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.

Success Of Radical Prostatectomy

The goal of radical prostatectomy is to cure prostate cancer. However, prostate cancer cure is only possible from prostatectomy if prostate cancer is limited to the prostate.

During radical prostatectomy, the removed prostate is examined under a microscope to see if prostate cancer has reached the edge of the prostate. If so, the prostate cancer has probably spread. In these cases, further treatments may be needed.

Men with no evidence of prostate cancer spread have an 85% chance of surviving 10 years after radical prostatectomy.Ã

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The Radical Prostatectomy Procedure

A radical prostatectomy is used to surgically remove the prostate. Surgeons typically access and remove the prostate gland via an incision made in the lower abdomen. Laparoscopic prostatectomies which incorporate robotic, keyhole surgery are also available, although opinions are divided as to which method provides the greatest accuracy and optimal results.

Rise Of Robotic Radical Prostatectomy

Laparoscopic radical prostatectomy for prostate cancer

Menon et al from the Vattikuti Urology Institute at Henry Ford Hospital in Detroit, Michigan, are responsible for the development and popularization of robotic radical prostatectomy. This technique has been gaining widespread acceptance in the United States and Europe and is increasing in penetration worldwide. Robotic radical prostatectomy offers the advantages of the minimally invasive laparoscopic approach but shortens the learning curve, facilitating and hastening mastery of the procedure.

Although solid basic laparoscopic skills are required for access and assistance, the console surgeon role requires less laparoscopic skill. Therefore, the procedure is accessible to experienced open-procedure surgeons with minimal or no laparoscopic experience. In a published report, Badani et al have performed more than 2700 robotic prostatectomies and have reported a mean operative time of 154 minutes, a mean blood loss of 100 mL, and hospital stays of less than 24 hours in 96.7% of patients.

The following image provides a portion of a minimally invasive radical prostatectomy.

Go to Prostate Cancer and Laparoscopic Pelvic Lymph Node Dissection in Prostate Cancer for more information on these topics.

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Advantages And Disadvantages Of Laparoscopic Transperitoneal Approach

The advantages of the transperitoneal approach include familiarity with anatomy, adequate space for dissection, and the presence of several reference points to aid the surgeon in orientation. Maximum mobility of the bladder is achieved in this approach, which helps provide a tension-free urethrovesical anastomosis.

Disadvantages of the transperitoneal approach include communication of the anastomotic site to the peritoneal cavity with the potential for peritoneal urine leak and ascites. The transperitoneal approach also increases the risk of bowel injury, ileus, and adhesions.

Risks Of Prostate Surgery

The risks with any type of radical prostatectomy are much like those of any major surgery. Problems during or shortly after the operation can include:

  • Reactions to anesthesia
  • Blood clots in the legs or lungs
  • Damage to nearby organs
  • Infections at the surgery site.

Rarely, part of the intestine might be injured during surgery, which could lead to infections in the abdomen and might require more surgery to fix. Injuries to the intestines are more common with laparoscopic and robotic surgeries than with the open approach.

If lymph nodes are removed, a collection of lymph fluid can form and may need to be drained.

In extremely rare cases, a man can die because of complications of this operation. Your risk depends, in part, on your overall health, your age, and the skill of your surgical team.

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Patient Positioning And Abdominal Access

Regardless of the technique used, the patient is placed in the supine position with the head down. This head-down position allows for gravity to facilitate the natural retraction of the pelvic tissues. If the procedure is to be performed transperitoneally, a periumbilical incision is made to provide access for the initial laparoscopic port. A Veress needle or Hasson-type trocar is used to establish pneumoperitoneum and to facilitate the laparoscopic survey of the abdomen. The Veress needle is an ideal access device when the patient has no history of abdominal surgery. In patients who have undergone previous abdominal surgery, particularly involving infraumbilical incisions, the Hassan trocar is ideal for direct visualization and confirmation of entrance into the peritoneal cavity.

Carbon dioxide is then insufflated into the abdomen to achieve pneumoperitoneum. If a Veress needle was used for initial access, it is replaced by a 12-mm radially dilating laparoscopic trocar. The 3-dimensional robotic laparoscope is then inserted through the infraumbilical trocar site, and a laparoscopic survey of the abdomen and pelvis is performed. If the procedure is to be performed extraperitoneally, the first steps for access consist of a small incision and development of the extraperitoneal space.

Open Or Laparoscopic Radical Prostatectomy

A – Intro: Robotic-Assisted Laparoscopic Radical Prostatectomy | City of Hope

In the more traditional approach to prostatectomy, called anopen prostatectomy, the surgeon operates through a single long skin incision to remove the prostate and nearby tissues. This type of surgery is done less often than in the past.

In a laparoscopic prostatectomy, the surgeon makes several smaller incisions and uses special long surgical tools to remove the prostate. The surgeon either holds the tools directly, or uses a control panel to precisely move robotic arms that hold the tools. This approach to prostatectomy has become more common in recent years. If done by experienced surgeons, the laparoscopic radical prostatectomy can give results similar to the open approach.

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Making Decisions About Surgery

Talk to your surgeon about what types of surgery are available to you. Ask about the advantages and disadvantages of each option. There may be extra costs involved for some procedures and they are not all available at every hospital. You may want to consider getting a second opinion about the most suitable type of surgery.

The surgeons experience and skill is more important than the type of surgery offered.

Compared to open surgery, both standard laparoscopic surgery and robotic-assisted surgery usually mean a shorter hospital stay, less bleeding, a smaller scar and a faster recovery. Current evidence suggests that the different approaches have a similar risk of side effects and no difference in outcomes.

Whichever surgical approach is used, a radical prostatectomy is major surgery and youll need time to recover.

Robotic Radical Prostatectomy Advantages

If you are considering a robotic prostatectomy for prostate cancer, our top surgeons perform a high volume of robotic-assisted radical prostatectomy for prostate cancer treatment. This new technology allows your surgeon to have a high-definition view of your prostate and the surrounding areas, resulting in more precise surgery.

The advantages to robotic-assisted prostatectomy as opposed to traditional surgery may include:

  • Less blood loss/fewer transfusions
  • Shorter hospital stay
  • Quicker recovery and return to normal activities

Seeking your prostate cancer treatment at Jefferson means you will have access to some of the most highly skilled and best trained urologists and other prostate cancer specialists right here in the Philadelphia area. The Kimmel Cancer Center at Jefferson is a National Cancer Institute -designated clinical cancer center for excellence in cancer care and research.

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Advent Of Robotic Surgical Technology

The next significant advance in the surgical treatment of localized prostate cancer was the development of robotic surgical technology. Initially developed by the United States Department of Defense for use in military battlefield applications, robotic technology was adapted for civilian use through the entrepreneurial efforts of 2 rival corporations, Intuitive Surgical, Inc, and Computer Motion, Inc. These companies simultaneously developed robotic interfaces for use in human surgical applications. Computer Motion, Inc, introduced the Zeus Surgical System at approximately the same time that Intuitive Surgical, Inc, developed its da Vinci Surgical System.

Both technologies relied heavily on a laparoscopic patient-robot interface in which instruments were placed through small trocars implanted in the patients skin. The working field was maintained predominantly by insufflation of the peritoneal cavity with carbon dioxide. Subsequently, Intuitive Surgical, Inc, acquired Computer Motion, Inc, consolidating the robotic surgical technology and making Intuitive Surgical, Inc, the sole provider of advanced robotic technology for use in human surgical procedures.

Several other companies also develop and manufacture robotic surgical technology, including single robotic arms for laparoscopic cameras or as part of integrated minimally invasive operating-room systems, but none of these rival technologies can compete with the advanced robotic engineering by Intuitive Surgical, Inc.

How Long Does This Surgery Take

Radical Prostatectomy

Although this surgery takes approximately 3 hours to perform, patients generally feel much better and have significantly fewer pain requirements in the early operative period. Unlike open surgery where the catheter stays in for two to three weeks, most laparoscopic prostatectomy patients have their Foley catheters removed on the third day after surgery.

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Incision Of The Dorsal Venous Complex And Urethra

This is the final step of the dissection. Using a 0° lens with 1:3 scaling, the dorsal venous complex is incised tangentially to the prostate to avoid capsular incision. A plane between the urethra and dorsal venous complex is gently developed to expose the anterior urethral wall. The Foley catheter is reinserted and used to identify the anterior surface of the urethra at the urethroprostatic junction. The anterior wall of the urethra is transected with the scissors a few millimeters distal to the apex of the prostate .

The posterior wall of the urethra and the rectourethralis muscle are cut under direct vision. The freed specimen is then examined for adequacy of resection margins and is placed in a specimen-retrieval bag.

How Long Has Cleveland Clinic Been Performing Laparoscopic Prostatectomies

Cleveland Clinic has the most experience of any health care center in the United States related to laparoscopic prostatectomy. Our specialists have been performing laparoscopic prostatectomy procedures for the past three years.

We are investigating the long-term effects of the procedure versus the open radical prostatectomy. Preliminary results suggest that return to continence and potency is comparable to that of the open procedure.

Our staff will provide a comprehensive evaluation and refer you to the appropriate physicians for your specific condition.

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Robotic Radical Laparoscopic Prostatectomy Outperforms Open Surgery

A results of a study recently published in ¹European Urology the official journal of the European Association of Urology compared the outcomes of localised prostate cancer patients who received either open surgery Retropubic Radical Prostatectomy or keyhole Robotic Radical Laparoscopic Prostatectomy the results reflected favourably on the latter.

During the controlled and methodical, retrospective study, 4003 patients provided post-op feedback via questionnaires, one, two and eight years after their operations which were performed between 2008-2011 throughout fourteen Swedish clinics .

Despite both short and long-term data from either RRP or RALP showing insignificant change where urinary incontinence was concerned, the study did confirm it was the primary patient outcome. The post-op feedback gathered also provided further insight, finding that far fewer RALP patients experienced ED following their procedures.

PCSM rates amongst RALP patients were also found to be lower . As well as proving the minimally invasive RALPs to be oncologically safe, their potential to provide prostate cancer treatment specialists with wider functionality during operations was also recognised.

Potential Risks And Side Effects

B – Preparing for Surgery: Robotic-Assisted Laparoscopic Radical Prostatectomy | City of Hope

Its important to be aware of potential side effects and risks associated with a radical prostatectomy.

Immediately after the surgery, risks may include:

  • Reaction to the anesthesia
  • Infections at the surgery site
  • Damage to other organs near the prostate

You should also ask your doctor about side effects. Some of the most commonly experienced side effects from the surgery include:

  • Impotence or temporary erectile dysfunction
  • Infection
  • Incontinence or urine leakage
  • Inguinal hernia

Not all patients experience side effects, and side effects arent always permanent. However, if you experience long-term side effects, treatments are available for some of the main issues, such as erectile dysfunction and urinary incontinence.

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Progression Of Laparoscopic Radical Prostatectomy

The first successful laparoscopic radical prostatectomies were performed by Schuessler in 1992 and 1997. Unfortunately, the technique did not gain widespread acceptance because of its extreme technical difficulty and because it offered no advantage over the criterion standard of open radical retropubic prostatectomy. The initial series reported operative times that ranged from 8 to 11 hours and a mean hospital stay of 7.3 days.

The laparoscopic approach gained new attention when 2 French groups published their experience with laparoscopic radical prostatectomy in 1999 and 2000. They reported modifications to the original technique, resulting in operative times that ranged from 4 to 5 hours and had a mean blood loss of 402 mL. The authors also reported a decreased mean hospital stay, due predominantly to earlier removal of the Foley catheter.

Even in the hands of these skilled laparoscopists, nerve-sparing dissection and construction of the urethrovesical anastomosis were demanding. With advances in medical technology, improved optics, and the widespread use of new laparoscopic instrumentation such as ultrasonic cutting and coagulating devices , laparoscopic radical prostatectomy began to gain acceptance and was increasingly performed in several high-volume centers worldwide. However, the technical demands of laparoscopic radical prostatectomy prevented its widespread use by the average urologist and thus limited penetration.

What Happens Before Radical Prostatectomy

Your doctor will enquire about your medical history before performing a radical prostatectomy in India. You will also need to inform your doctor about any medications or vitamins you are taking. Some medications, particularly those that cause blood thinning, may need to be stopped a few days before surgery.

Your hospital will give you specific instructions, including how long you should wait to eat and drink before the surgery.

You may also require the following tests to assess your health before your procedure:

  • Blood tests
  • A CT or MRI scan of your pelvis and abdomen is recommended.
  • Ultrasound and biopsy of the prostate.
Radical Prostatectomy Cost in India
  • Cost

The radical prostatectomy cost in India starts from USD 6500.

As we all know, India is one of the leading countries in the world for providing high-quality healthcare at a low cost. The cost of radical prostatectomy in India is a fraction of the cost of a similar surgery in any other country.

Procedure

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Radical Prostatectomy Retropubic Or Suprapubic Approach

  • You’ll be positioned on the operating table, lying on your back.

  • An incision will be made from below the navel to the pubic region.

  • The doctor will usually perform a lymph node dissection first. The nerve bundles will be released carefully from the prostate gland and the urethra will be identified. The seminal vesicles may also be removed if necessary.

  • The prostate gland will be removed.

  • A drain will be inserted, usually in the right lower area of the incision.

  • Advantages And Disadvantages Of Laparoscopic Extraperitoneal Approach

    Robotic Prostatectomy

    Theoretical advantages of the extraperitoneal approach include its feasibility in patients who have undergone extensive abdominal surgeries and its minimal associated risk of bowel injury. The peritoneum acts as a self-retractor for the intestines, thus obviating the need for steep Trendelenburg positioning. Reports of simultaneous inguinal hernia repairs using prosthetic mesh have been published.

    The most significant limitation of this approach is the lack of adequate space for dissection and suturing. In addition, because the peritoneal and urachal attachments of the bladder are not divided, tension at the urethrovesical anastomosis is a concern. As a result, the extraperitoneal approach should be performed only by experienced laparoscopic surgeons.

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    Complications Of Laparoscopic Radical Prostatectomy

    As with any surgery there is a small risk of complications, such as:

    • infection

    Specific complications of laparoscopic radical prostatectomy include:

    • difficulty passing urine
    • erectile function
    • damage to other organs.

    The healthcare team will do their best to minimise any risks. Make sureyou discuss any concerns you have about these complications with yourconsultant.

    Advantages Of The Radical Prostatectomy Procedure

    Whereas laparoscopic prostatectomies can provide patients with shorter recovery times, radical prostatectomies dont automatically induce ongoing or irreversible erectile dysfunction or incontinence. ¹Accuracy is key during either procedure, but a surgeons personal experience is also recognised as critical when minimising or avoiding unnecessary damage during the operation.

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    Equipment For Robotic Radical Prostatectomy

    Currently, the only available integrated robotic surgical system is the da Vinci Surgical System . This computer-aided system has a basic master-slave design. A second generation of this system is currently available .

    The surgeon console

    This is the user interface of the robot for the surgeon and consists of the following:

    • Display system: The system is a 3-D stereoscopic display for the console surgeon and is generally available for view in 2-D form by assistants and observers.

    • Master arms: These are the controls the surgeon uses for making surgical movements. Movements of the master arms translate to real-time movements of the instrument tips and may be scaled for fine movements. The master arms also provide basic force feedback to the surgeon but are limited in their ability to discriminate complex haptic feedback. Camera movements are controlled with a clutch mechanism. In the 4-arm systems, the surgeon can toggle between instruments.

    • Control panel: The control panel is used to adjust the surgeon console display and control options. The control panel allows toggling between 2- and 3-D display, adjusting various levels of scaling, and choosing the camera perspectives .

    • Central processing unit: This is the computer that controls the system and integrates and translates robot control inputs from the surgeon.

    Robotic arms

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