Complications Of Robotic Prostate Surgery
Although robotic prostatectomy is associated with fewer risks compared to traditional surgery, it is still not completely risk-free. Occasionally, complications might occur:
- Bleeding: Seen as bloody urine postoperatively. If it doesnt resolve on its own, further intervention might be necessary.
- Infection: Surgical site infection is a risk with any surgery. It is treated with antibiotics.
- Damage to the bladder or colon: Since the bladder and colon are in close proximity to the prostate, they might be damaged during surgery.
Choosing A Prostate Cancer Treatment: Surgery Versus Radiation
Although many treatment options are available, patients with newly-diagnosed prostate cancer often narrow down the choices to two surgical removal of the prostate or radiation therapy. Since many factors influence this decision, choosing which treatment to use can be daunting.
The biggest advantage to radiation therapy is that it is easier to undergo than surgery. Even with robotic technology, its small incisions are not as small as the openings made by a couple of dozen needles inserted into the skin behind the scrotum when radiation seeds are implanted. General recovery from robotic prostatectomy is usually 2-3 weeks, whereas recovery from radioactive seed implantation is 1-2 days. Many patients who choose the radiation route will also undergo daily external beam treatments for 6-7 weeks.
The biggest advantage to surgical removal is the information learned that is not available through other treatment methods. Once the prostate is removed, it can be fully analyzed to determine the extent, location, and grade of the disease within the prostate and seminal vesicles . More important, the ability to monitor a patient for possible recurrence is dramatically enhanced. When the prostate is removed, the PSA blood test should become undetectable within six weeks if all the cancer cells have been successfully eliminated. Prostate cells are the only source of PSA, a protein made by these cells and partially released into the blood stream.
Robotic Surgery Vs Conventional Surgical Approaches
- Annals of Surgery
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Robotic Prostate Surgery Details
Using the advanced surgical system, miniaturized robotic instruments are passed through several small keyhole incisions in the patients abdomen to allow the surgeon to remove the prostate and nearby tissues with great precision. This is much less invasive than a conventional radical retropubic prostatectomy, which involves an abdominal incision that extends from the belly button to the pubic bone.
During robotic-assisted radical prostatectomy, a three-dimensional endoscope and image processing equipment are used to provide a magnified view of delicate structures surrounding the prostate gland , allowing optimal preservation of these vital structures. The prostate is eventually removed through one of the keyhole incisions.
For most of the surgery, the surgeon is seated at a computer console and manipulates tiny wristed instruments that offer a range of motion far greater than the human wrist. The surgery is performed without the surgeon’s hands entering the patients body cavity.
What Procedures Can Be Performed With Robotic Surgery
The surgeons who perform robotic surgeries at USMD Hospital at Arlington have performed more than 16,900 robot-assisted surgeries since 2003. Patients have received minimally invasive surgery for a variety of medical conditions or issues that interfere with their health and quality of life.
During a robotic procedure, a surgeon guides the da Vinci Surgical System mechanisms while viewing 3D high-definition images of the surgical area. Our goal is to make procedures as safe and accessible as possible. This is why we offer robotic techniques for the following:
- General surgery
- Hysterectomy and other gynecological procedures
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Surgery For Prostate Cancer : Introduction
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 About Problems With Urinary Continence
Urinary continence depends on the internal, involuntary sphincter and the voluntary striated external sphincter. The internal sphincter is removed during all forms of prostatectomy, as it is anatomically at the junction of the prostate and bladder. Performing specialized Kegel exercises after surgery to strengthen muscles enables patients to control their external sphincter and gain continence . This takes several weeks to several months. Overall, significant urinary leakage occurs in only 0.5 percent of UC Davis patients. About 15 percent of patients report mild stress incontinence.
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Lefrak Center For Robotic Surgery And Institute Of Prostate Cancer
The Lefrak Center for Robotic Surgery is dedicated to the care of patients with prostate cancer using innovative MRI based diagnostic and staging approach and provides comprehensive care involving active surveillance, focal therapy, robotic prostatectomy, radiation and medical therapy. The Center has performed over 3500 robotic procedures and its faculty have published extensively about their outcomes in peer reviewed literature. For more information visit .
What Are The Benefits Of Surgery
The success rate for surgery to treat prostate cancer is very high when all the cancer is removed. Surgical treatment is generally safe, with most men making a full recovery within two months after surgery.
Further, surgery provides information about the exact genetics and state of cancer. Genetic analysis of surgically removed prostate tissue allows doctors to estimate prognosis and plan any complementary treatments.
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Robot Assisted Prostate Cancer Surgery Compares Favorably To Other Surgical Techniques
First Large Meta-Analysis to Examine Differences Between Three Types of Curative Prostate Surgeries
NEW YORK
Outcomes from use of a robot to assist surgeons in removal of a cancerous prostate are at least as good, if not better, than the other two techniques used for a radical prostatectomy open or laparoscopic surgery according to a large meta analysis led by researchers at NewYork-Presbyterian/Weill Cornell.
The study, published February 24 online in European Urology, should help resolve some of the controversy regarding use of the robotic option, known as robot assisted laparoscopic radical prostatectomy , says the study’s lead author, Dr. Ashutosh Tewari, director of the Lefrak Center for Robotic Surgery and director of the Prostate Cancer Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center.
“There is a lot of debate about the best way to remove a cancerous prostate gland,” says Dr. Tewari, who is also the Ronald P. Lynch Professor of Urologic Oncology and professor of urology and public health at Weill Cornell Medical College. “Since the robotic technology is expensive, the patient benefits often get intertwined with the societal costs. It is clear, however, that robotic surgery is the most popular surgical modality today. This study represents the largest ever systematic review of patient outcomes comparing robotic-assisted, laparoscopic and open radical prostatectomy.
What The Study Found
According to the results, both methods were equally effective at removing cancer from the body, and post-surgical complications between them occurred relatively infrequently. However, there were some short-term differences between the two approaches. For instance, the robotically-treated men had shorter lengths of hospital stay , and they also reported lower pain scores after surgery. Men who underwent robotically-assisted surgery also reported fewer complications such as blood clots , urinary tract infections , and bladder neck contracture, which is a treatable condition that occurs when scarring in the bladder outflow makes it hard to urinate. In all, 45 men experienced a bladder neck contracture after open surgery, compared to nine men treated with the robotic method.
This is an excerpt from an article that appears on the Harvard Health Publishing website.
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Robotic Vs Open Surgery For Prostatectomy: Which Wins
Kristin Jenkins
At 24 months’ follow-up, the only phase 3 randomized clinical trial to directly compare functional and oncologic outcomes between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy shows no evidence for a clear advantage of one approach over the other, say researchers.
The international study was led by Robert “Frank” Gardiner, MD, from the University of Queensland Center for Clinical Research at Royal Brisbane and Women’s Hospital, Australia.
The new results at 24 months’ follow-up were July 12 in the Lancet Oncology.
As previously reported by Medscape Medical News, the trial’s 3-month follow-up results, published in 2016, showed no significant differences in functional and oncologic outcomes between the two approaches.
The current study shows that functional and sexual outcomes for both approaches have remained comparable at 6, 12, and 24 months’ follow-up.
However, the oncologic outcomes “require ongoing follow-up and further investigation,” the authors say.
The study also showed that 1 of 5 patients continued to experience high levels of psychological distress, regardless of surgical approach.
The researchers “advise caution in interpreting the oncological outcomes of our study because of the absence of standardization in postoperative management between the two trial groups and the use of additional cancer treatments.”
Robotic Surgery For Prostate Cancer
With the advancements in technology, radical prostatectomy can now be performed with minimally invasive procedures like laparoscopy and robotic prostate cancer surgery.Robotic surgery is the modern-day enlightened method of surgery that makes use of cutting-edge technology. Surgeons can conduct complex surgeries with greater precision and flexibility, thanks to robot-assisted surgeries. Robotic surgery requires extremely small incisions that are precisely done. The most noteworthy advantage of robotic surgery is that it offers surgeons a clear and magnified view of the surgical site. With a highly defined view, surgeons can easily perform the surgery with maximum accuracy. The precision of the robot allows robotic surgery to be significantly more exact than traditional surgery procedures. Robotic prostate cancer surgery is also known as robotic prostatectomy. Surgical removal of the prostate and surrounding tissues is the standard treatment option if the prostate cancer has not spread outside the prostate gland. Procedures involved in robotic prostate cancer surgery cause minimal tissue damage and comparatively less blood loss to the patient, resulting in quicker recovery time. Moreover, there are fewer chances of infections caused during the surgeries and even fewer visible scars as compared to traditional surgeries.
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Top Prostate Cancer Surgeon
Dr. Razdan is considered by many as one of the Most Experienced Robotic Prostate Cancer Surgeons in the Worldwith over 8,500 procedures performed to date. He is considered a Pioneering Researcher and Surgeon on Prostate Cancer and has some of the best Robotic Surgery Outcomes in the world. Patients travel from all around the world to Miami to have Prostate Cancer Surgery with Dr. Razdan. From CEOâs of large corporations, celebrities, government officials and even other surgeons entrust Dr. Razdan and his unique set of skills and incredible outcomes. He was the First Surgeon in the World to USE HUMAN AMNIOTIC MEMBRANE for EARLY RETURN of ERECTILE FUNCTION after robotic prostate surgery. He founded and pioneered the technique of MAXIMAL URETHRAL LENGTH PRESERVATION for EARLY RETURN OF URINARY CONTINENCE after robotic prostate surgery which was also published Patients travel to Dr. Razdan for his leading outcomes in terms of Cancer Control, Urinary Continence and Erectile FunctionMost patients have full urinary control often within days of surgery and almost 98% are continent by 6 monthsMajority of patients have erections sufficient for sexual activity by 6 months
Pencil Beam Scanning Proton Therapy
Pencil beam scanning is one of the most common ways to deliver proton therapy for prostate cancer. Another common method is double-scattered beam therapy.
With pencil beam scanning proton therapy, medical professionals are able to manipulate and focus the proton beams to a greater extent. This results in a more precise dose of radiation than double-scattered therapy, sparing surrounding tissue even more.
However, the difference in outcomes is minimal, according to
Side effects may include fatigue and skin redness or soreness where you had treatment. You may also have issues with incontinence or gastrointestinal side effects. Erectile dysfunction is another risk of radiation treatment.
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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.
Will Anything Come Of Jan 6 Hearings
An operation called a radical prostatectomy has long been a mainstay of prostate cancer treatment. Offered most often to men whose cancer has not yet begun to spread, it involves removing the entire prostate gland, and can be performed in different ways. With the traditional open method, surgeons remove the prostate through an 8- to 10-inch incision just below the belly button. Alternatively, surgeons can perform a robot-assisted radical prostatectomy. With this approach, miniaturized robotic instruments are passed through several much smaller incisions in the patients abdomen. Surgeons control these instruments remotely while sitting at a console.
At least 85 percent of all radical prostatectomies in the United States today are performed robotically. But how do those high-tech surgeries compare with the traditional open method?
Most studies show no major differences between the procedures in terms of patient survival or their ability to control prostate cancer over the long term. Robotic prostatectomies ostensibly offer quality-of-life advantages for urinary function and sexual health. However, the supporting evidence comes mostly from doctors reports, insurance claims-based data, or studies too small to generate definitive conclusions.
Now, results from a much larger comparative study provide needed clarity.
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Side Effects Of Robotic
The rates of major side effects from robotic-assisted laparoscopic radical prostatectomy are about the same as open surgical approaches. The most common side effects include the following:
-
Urinary incontinence : Similar to open surgery, urinary incontinence can occur following a robotic prostatectomy. However, this side effect often improves over time.
-
Erectile dysfunction : The return of erectile function following prostatectomy is based on the patients age, degree of preoperative sexual function and whether the nerves were spared during surgery. Unless cancer is suspected in the nerve tissue, surgeons will use nerve-sparing techniques during robotic prostatectomy to minimize the surgical impact on sexual function.
Robotic Prostate Surgery | Q& A
Thanks to advances made by surgeons like Dr. Patrick Walsh, The Brady Urological Institute at Johns Hopkins offers unparalleled prostatectomy expertise. Learn more about prostate cancer surgery and the difference between open and robotic procedures from Dr. Mohamad Allaf.
Why Is A Robotic Prostatectomy Better Than Open Or Laparoscopic
To understand why things have evolved such that well over 90% of prostatectomies in America today are done robotically, one must be given a brief history lesson of radical prostatectomy. Much of this was already reviewed in the prostate cancer section of this site, but the discussion is more expansive here.
In the 1980s, Urologists knew only one way to operate on the prostate, and that was through an incision made under the scrotum. This was and is called a perineal prostatectomy, and this approach was also used to biopsy the prostate before the advent of trans-rectal ultrasound. In the 1980s, widespread PSA screening did not exist, and thus patients were rarely found with prostate cancer in its early, curable stage. Thus, a perineal prostatectomy was a rare operation, and most surgeons were not highly experienced in doing it. This approach did not provide good access to spare the erectile nerves. Because of this, most patients opted for external beam radiation. Unfortunately, back then radiation was poorly focused and caused very significant side effects, causing the dose to be too low and therefore the cure rates also to be low.
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What Are Laparoscopic And Robotic Surgery
Laparoscopic and robotic prostate surgery are minimally invasive techniques for performing surgery. Both these procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally invasive surgery with advanced robotic technology.
Challenges Of Randomized Studies For Prostate Surgery
The three forms of surgery studied are “open radical” in which the prostate is removed via an abdominal incision in the belly button or pubic bone laparoscopic prostatectomy that requires several small minimally invasive “keyhole” incisions in the abdomen, and robotic surgery, which is a form of laparoscopic surgery. RALP is done through keyholes with the aid of robotic arms that eliminate hand tremor as well as advanced optics that magnify the prostate and surrounding nerves in three-dimensions.
“It is hard to accrue patients for randomized studies. We have an ongoing study open at our institution, investigating the quality of life differences between robotic and open radical prostatectomy. This is designed as a randomized controlled study,” he says. “But no one has enrolled because they did not want to be randomized to a treatment they don’t prefer. Patients often come, especially to prostate cancer specialists, self-selecting for a particular treatment modality.”
So Dr. Tewari and Peter Wiklund, M.D., of Sweden’s Karolinska University Hospital, developed a study that examined all of the peer-reviewed studies published on any of the three techniques.
This ambitious effort was aimed at understanding the short-term outcomes of the three surgical techniques. Given the short time frame, the meta analysis did not compare outcomes for urinary continence or sexual potency.
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