When prostate cancer is primarily limited to the prostate gland itself, surgery is often the recommended treatment if the “active surveillance” approach is no longer appropriate.
Robot assisted prostatectomy has replaced the open radical prostatectomy as the preferred method for surgical removal of the prostate which is aimed at curing prostate cancer.
What is a Robot Assisted Prostatectomy?
In a robot assisted prostatectomy, smaller incisions, sometimes referred to as keyhole incisions, are made and specialized instruments are used through these incisions to remove the prostate. Robotic surgery involves the incorporation of advanced and sophisticated robotic technology designed to be minimally invasive and highly precise.
Who is a Good Candidate for This Procedure?
Generally, any man who has a prostate gland that needs to be removed because it has been affected by cancer is a possible candidate for this type of surgery. Patients are typically evaluated to determine if there are underlying health issues that could complicate surgery. You may also be asked to stop taking blood-thinning medications prior to having robot assisted prostate gland removal to minimize bleeding risks.
Robot assisted prostatectomy is the first line of therapy for most men but other treatments such as radiation or hormonal therapy can be added later on if there are signs of recurrence after surgery.
How is Robotic Assisted Surgery Performed?
A robot assisted prostatectomy involves the use of a robotic surgical system that may be better thought of as computer assisted surgery. The robotic instruments are inserted through the keyhole incision and then four of these instruments including a camera are held by the robotic cart that stands next to the patient. The surgeon is in complete control of the procedure as the robot does not move on its own but are under the direct control of the surgeon from the console.
The surgeon’s hand and foot controls direct the movements of surgical instruments while seated at the specially designed console in the same room where the surgery is being performed. A table side assistant helps the surgeon with suctioning and passing instruments in and out of the surgical field.
During the procedure, the surgeon has a magnified 3-D view of surgical area. The robotic instruments are very small and have a wrist at the tips that allows for a greater range of motion than what’s possible with human hands and handheld instruments. The robotic platform also filters any hand tremor and thus remains steady at all times, allowing the surgeon to have precise control over tissue removal. The motions of the instruments are also scaled to allow precise movements for delicate dissection and reconstruction. These advantages allow for very precise dissection ability and preservation of vital structures. It typically takes about 90-120 minutes for Dr. Lee to perform a robot assisted prostatectomy.
What are the Advantages of Robot-Assisted surgery?
Because of the smaller incisions and laparoscopic approach, patients are usually discharged the same day as the surgery. They are able to take regular food right away and are encouraged to start walking as much as possible by the next morning. They are usually able to go back to work by two weeks and can resume all normal activities such as golf, tennis, lifting, etc. by three weeks. This would usually take three months with an open prostatectomy.