Prostatectomy At Brigham And Womens Hospital
Most prostatectomy procedures at Brigham and Womens Hospital are performed robotically. Robotic radical prostatectomy surgery uses a combination of high-definition 3D magnification, robotic technology, and miniature instruments to enhance a urologic surgeons skills when removing a cancerous prostate gland.
Adam S. Kibel, MD, Chief of Urology, and Steven L. Chang, MD, MS, use the FDA-approved da Vinci® Surgical System to perform hundreds of robotic prostatectomies each year. The system consists of a surgeons console, equipped with a control panel and a hi-definition monitor, and a patient side-cart, outfitted with slender robotic arms and attended by another surgeon and a nurse.
Unlike traditional open prostate surgery, which requires one large incision and retraction to accommodate human hands, only tiny incisions in the abdomen are required for the slender robotic arms and tiny surgical tools used in a robot-assisted prostatectomy. There are four available arms one equipped with a high definition 3-D magnification camera, two that act as the surgeons arms and a fourth arm that is used for holding back tissue. The camera gives the surgeon enhanced detail, true depth of field and a panoramic view, and the robotic hands broad range of movement enables greater dexterity.
Robotic surgerys miniaturization, increased range of motion, enhanced vision and mechanical precision offer significant benefits for our prostatectomy patients, including:
Reducing The Risk Of Erectile Dysfunction
To minimise your risk of impotence following the operation, any factors that might predispose you to erection problems should be addressed beforehand. Such risk factors include:
- smoking
- obesity and
- diabetes.
Your doctor will assess your risk and offer treatment or advice if necessary. They will also make sure that you are not taking any medicines that could contribute to erectile dysfunction.
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.
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Optimal Outcomes Of Robotic Prostate Surgery
He had a very quick recovery, he was back and able to work to a limited capacity 2 and half weeks after surgery. Subsequently, he had several 0 PSA tests, incontinence is no longer an issue and everything started to work as expected.
After his experience, he gives Dr. David Samadi the strongest possible endorsement!
Did you know?
- David Samadi has performed more than 7500 robotic prostatectomies
- The surgery lasts about 1 hour and a half, with minimal blood loss and a fast recovery
- Most patients regain their sex life and normal urinary functions in 6-12 months after the robotic surgery
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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What Are The Side Effects Of Prostate Radiation
Even though both external beam radiation and brachytherapy use the same radiation as the cure from the cancer cells, they have some common side effects.
- Bowel problems: Radiation proctitis is a very common inflammation of the rectum that occurs as a result of the radiation treatment of prostate cancer where damage to the rectum was acquired. Proctitis can lead to diarrhea, with the blood in the stool, and rectal leakage. Most of these problems go away over time, but in rare cases, normal bowel function does not return. In order to minimize bowel problems, doctors will advise what kind of diet to follow during radiation therapy to help limit bowel movement during treatment.
- Urinary problems: Radiation cystitis is the side effect of inflammation and subsequent destruction of the normal work of the urinary bladder at the cellular level after the usage of radiation in the treatment. Patients will feel the need to urinate more often, have a burning sensation while the urinate process, and/or find blood in the urine itself. Urinary problems usually improve over time, but in some men, they never go away.
- Erection problems : Patience after the treatment, with radiation or through surgery, has the same rate of impotence level. These problems do not occur right after radiation therapy but are slowly developing over time. The effect of radiation treatment is more visible if the patient is elderly, where impotence is already on the low level.
What Is A Common Misconception You Find In Patients Regarding Complications That Might Occur After Prostate Cancer Surgery
I have found that patients often misunderstand the real meaning of percentages doctors give them about the likelihood of recovering their function. A patient might be told that their chance for recovery of erections is 75 percent. A lot of patients interpret that as meaning, I have a 75 percent chance of returning to my baseline function. It actually means 75 percent of patients will be able to get a functional erection, often with the aid of a pill. Unless the doctor makes this clear to them, many patients will be disappointed. When a percentage is quoted, patients should ask their surgeons what it actually means because as is usually the case the devils in the details.
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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.
Possible Side Effects Of Radiation Treatment For Prostate Cancer
The radiation used to destroy cancer cells can also hurt normal cells in the nearby area. Side effects from radiation treatment are related to the area of the body being treated. Patients start to have side effects a few weeks into their treatment. While side effects may be unpleasant, there are treatments to help deal with them. Most side effects are temporary and slowly start to go away once treatment is done.
You will be seen by your radiation oncology providers often during treatment. These visits are a chance to ask questions and to talk about any side effects and how to best manage them. You can also call your providers to speak about any side effects.
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What Advice Would You Give To A Patient Who Wants To Keep The Risk Of Surgical Complications As Low As Possible
There are some things that patients cant control, such as their age, their baseline functionality, or the nature of their cancer. But they can control the treatment choices they make. Patients should be aware that some cancers are found so early that immediate treatment is not necessary, and these tumors can be monitored closely through an approach called active surveillance a method weve pioneered very successfully here at MSK.
For patients opting to undergo radiation therapy or surgery, its critical to know the outcomes of the individual doctor. Its well established that surgeons or radiation oncologists who specialize in a specific treatment and do a high number of procedures have better outcomes.
These therapies are very effective. Its always a balance between removing the cancer and trying to preserve function, and the balance is different for each person because each cancer is different. One of the benefits of places like MSK is that we have experts who can help guide patients in regaining urinary and erectile function.
Ultimately its all about finding a surgeon or a radiation oncologist with whom you feel comfortable someone who sets realistic expectations based on your situation as a patient.
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:
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Urinary incontinence : Similar to open surgery, urinary incontinence can occur following a robotic prostatectomy. However, this side effect often improves over time.
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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
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Are There Differences Between Orp Lrp And Ralrp
According to a 2010 of different surgery types for prostate cancer, the outcomes for open radical prostatectomy , laparoscopic , and robotic-assisted prostatectomy are not significantly different.
But people who choose LRP and RALRP may experience:
- less blood loss
- shorter hospital stay
- faster recovery time
Also, people who choose RALRP report faster recovery in continence and decreased hospital stay, in comparison to LRP. But the overall outcomes still depend on the surgeons experience and skill.
Pelvic Radiation Therapy Effect On Erections
Prostate, bladder, colon, and rectal cancer are sometimes treated with radiation to the pelvis. This can cause problems with erections. The higher the total dose of radiation and the wider the section of the pelvis treated, the greater the chance of erection problems later. If radiation therapy is part of your treatment plan, talk to your doctor before it starts. Ask how your arteries and nerves might be affected by radiation therapy so you know what to expect.
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Things You Should Expect After Prostate Surgery
Prostate removal is a major type of surgery and requires time for the body to recover. Even though robotic prostatectomy using the Da Vinci robot has less severe effects on the body and the patient can leave the hospital the same day, men should expect some changes in order to know how to deal with them. The surgery is performed through small incisions that are barely sensitive at the incision sites and the scar tissue is almost unnoticeable. Typically, the recovery is fast, most men are able to go home the next day and resume driving and working in two to three weeks after the surgery.
In the immediate hours after surgery:
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Holmium Laser Enucleation Of The Prostate
Holmium laser enucleation of the prostate abbreviated as HoLEP or laser prostate surgery is another minimally invasive surgery. It is used to treat symptoms of BPH by removing blockages to urine flow.
This is achieved by inserting an instrument called a resectoscope into the urethra to get a visual of the prostate tissue and the lining of the bladder. Then a laser is used to cut away the obstructing tissue. Next, an instrument called a morcellator is used to cut the resected prostate tissue into smaller pieces. The tissue is then removed via the rectoscope.
Laser surgery is an effective way to operate on symptoms quickly and efficiently, and the procedure greatly reduces recovery time and postoperative complications.
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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.
Side Effects From Hormone Therapy
Hormone therapy for prostate cancer, known as androgen deprivation therapy , suppresses production of testosterone. ADT can cause several side effects. These include fatigue, hot flashes, decreased bone density, ED, depressed mood, decreased sex drive, weight gain, heart risks, breast growth and cognitive decline.
The severity and length of side effects depend on how long treatment lasts. “If a man has only six months of treatment, their level of testosterone rises again, and they’ll go back to feeling like themselves,” Calvaresi said.
Often, mood changes in men on ADT are caused by other side effects such as weight gain and hot flashes. “If we can manage those other side effects, then often that improves mood,” she said. Following a healthy diet and exercising regularly often helps to decrease fatigue, prevent weight gain and improve overall mood. Before beginning hormone therapy, you should discuss the effects of ADT with your doctor, and talk about how you can change your exercise and eating habits to help head off side effects before they occur.
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Types Of Prostate Surgery
There are several ways of removing the prostate keyhole surgery either by hand or robot-assisted, and open surgery.
Although robot-assisted keyhole surgery is the newest technique, the most recent research suggests all three techniques are as good as each other for treating prostate cancer, as long as the surgeon is experienced. They also have similar rates of side effects.
The advantages of keyhole surgery, both by hand and robot-assisted, are that you are likely to lose less blood, have less pain, spend less time in hospital, and heal more quickly than with open surgery.
Keyhole surgery
Keyhole surgery .
- Robot-assisted keyhole surgery Your surgeon makes five or six small cuts in your lower abdomen and a slightly bigger cut near your belly button, and removes the prostate using special surgical tools. These include a thin, lighted tube with a small camera on the tip. The image will appear on a screen so the surgeon can see what theyre doing. Your surgeon controls the tools from a console in the operating room via four or five robotic arms. Although its called robot-assisted, its still a surgeon who does the operation. You may hear the equipment called the da Vinci® Robot.
- Keyhole surgery by hand As with robot-assisted keyhole surgery, the surgeon will make four or five small cuts in your abdomen. But they will hold the surgical tools in their hands, rather than using robotic arms.
Open surgery
Disadvantages And Side Effects Of Robotic Prostate Surgery
Disadvantages or robotic prostate surgery include that the machine has no sense of touch, and so when the surgeon pushes on a tissue, it does not push back as it would if they were holding the instruments. With experience, the surgeon can compensate for this by watching the tissue and its response to movement.
A robotic prostate surgery system is very expensive, both to buy initially and to maintain. Each time a surgical operation is performed, many of the instruments must be thrown out and replaced, again increasing cost.
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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.
What About Impotence And Incontinence After A Robotic Prostatectomy
Robotic surgery is really only the performance of a radical prostatectomy with better tools. These tools are specifically designed to allow for a more elegant surgery in a small space with better vision. And although most robotic surgeons do believe that this leads to a minimization of impotence and incontinence, unfortunately these two side effects are a part of every mans recovery after any prostatectomy, regardless of how it is performed or who performs it. Many men will recover quickly and completely, but this should not be expected as the norm at all. Dr. Engel is very experienced, but still has patients that leak permanently, and certainly has men that have permanent erectile dysfunction after surgery and need help. Highly skilled robotic surgeons like Dr. Engel just have fewer of them, and he is committed to providing help to those who need or want it.
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Should I Make Any Lifestyle Changes Including In My Diet Or Physical Activity
Achieving and maintaining a healthy weight by eating a balanced diet with plenty of fruits, vegetables, and whole grains, and staying physically active, can help your overall health. These lifestyle changes can also have a positive effect for men with bone metastases, Tagawa says. Both diet and exercise, he says, are things that are under a mans direct control.
A healthy lifestyle can help you better manage side effects from treatment as well. Try setting small but realistic goals for yourself when it comes to eating a healthy diet and getting plenty of exercise.
While no single food is likely to have a benefit for prostate cancer, smart food choices may help you feel better day to day. Start by cutting out foods high in sugar, saturated fat, and added flavorings and preservatives.
If youre not sure which healthy foods to choose, ask your doctor for a referral to a dietitian. This specialist can help you develop a meal plan that includes foods that offer the best chance of slowing the cancers growth and keeping you as healthy as possible.
As an oncologist, Tagawa says he concentrates on treating the cancer itself, but hes aware that many of the men he sees with advanced prostate cancer are older and more likely than younger men to have health problems that can benefit from diet and exercise.
And if youre on hormone therapy, talk to your doctor about investing in some weights or elastic resistance bands to support your bone strength too.
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