ROBOTIC LAPAROSCOPIC RADICAL PROSTATECTOMY
If surgery is recommended to treat your prostate cancer, you may be a candidate for a new less invasive surgical procedure called the da Vinci Prostatectomy. This robotic assisted laparoscopic radical prostatectomy is a state of the art procedure that blends the surgeon's skills with new robotic laparoscopic technology that helps the surgeon see vital anatomic structures more clearly and perform a more precise surgical procedure. The system allows the surgeon's hand movements to be scaled, filtered, and translated into precise movements by miniature instruments within the operative site. The da Vinci surgical system has been successfully used in thousands of prostate cancer procedures worldwide. The da Vinci prostatectomy is more beneficial than open prostatectomy because it results in a shorter hospital stay, less pain, less blood loss and lower transfusions risk, less scarring, as well as a quicker recovery and return to normal activities.

OVERVIEW
Laparoscopic surgery involves placing small ports through the abdominal wall into the abdominal space. Carbon dioxide gas is used to inflate the abdomen cavity and create the room to see the structures within the abdomen and provide space for the instruments to move and work. Routine laparoscopic surgery has been effectively applied to many operations, the most common of which is removal of the gallbladder. Robotic surgery is building on the concept of laparoscopy, but provides instruments that the robot can control, dramatically enhancing movements within the abdomen not possible with conventional laparoscopic instruments.



The surgical robot consists of a main tower that is moved into position over the patient. Four separate arms are attached to special � inch diameter ports that are pre-positioned through the abdominal wall by the surgeon. One surgeon remains by the patient's side, placing the various instruments into the ports. The second surgeon is positioned at a console within the room, where he has the benefit of 3 dimensional vision and the ability to control the robot's camera arm, as well as the 3 surgical arms. The robot is supported by a powerful computer that integrates all the movements, and most importantly monitors many safety features. For example, it is impossible for any of the surgical arms to move, unless the physician is seated at the controls and is looking through the console. If at any point it is necessary during the procedure to convert to an open surgical approach, the robot can be disconnected within seconds and the surgeon on the field is able to take immediate action. With any type of laparoscopic procedure, it may be necessary to convert to an open procedure to control potential problems with bleeding, or to ensure a safe and complete removal of the prostate.

Radical prostatectomy involves removing the prostate gland completely to cure the cancer and reconstructing the urinary system so that normal bladder control is achieved and also sexual function can be maintained. Routine surgery for prostate cancer involves an incision that extends from the belly button, down to the pubic bone, just above the penis. The muscles are separated to gain access to the prostate gland and the anterior surface of the bladder. Robotic prostatectomy uses 5 to 6 openings, measuring less than half an inch to place instruments. The surgeon is in full control of the instruments throughout the procedure. At no point, does the machine do the surgery. . The system cannot be programmed nor can it make the decisions on its own. The da Vinci system requires that every surgical maneuver be performed with the direct input from your surgeon. There are sensors on the machine that insure the robotic arms move only when the surgeon's eyes are viewing the console display. The computer enhances the surgeon's vision by magnifying the surgical field 10X and providing 3-dimensional vision. The computer automatically removes the natural tremor of the surgeon and also improves the fine control of the manipulations. Larger movements on the console arms manipulated by the surgeon are reduced or scaled down to smaller movements by the robotic arms in the patient. The main advantage of the robotic instrument is that it mimics the movement of the surgeon's wrist within the patient's body. This allows delicate dissection and suturing not possible with regular laparoscopic instruments and with better vision than through a regular large incision. The less invasive aspect of the surgery does not compromise the ability to remove the prostate gland completely. Surgical margins are maintained, so that the cancer can be controlled just as effectively with robotic techniques as they are with open surgery.




The Robotic prostatectomy results in:
  • More accurate dissection
  • Less blood loss
  • Improved nerve sparing techniques
  • A more intricate reconnection of the bladder to the urethra to reconstruct the lower urinary tract
PREPERATION
The preoperative preparation for a robotic prostatectomy is the same as for open surgery. Lab work, complete history and physical, EKG and bowel prep are necessary. A general anesthetic is also required.

RECOVERY
Postoperatively, a catheter is left through the penis to drain the bladder. With a robotic prostatectomy, the catheter is usually removed in 7-10 days, as opposed to the 2-3 weeks with an open surgical technique. A small drain is left in the abdominal cavity, outside the bladder, in case there is a temporary urine leak. This drain is usually removed the day following surgery. In our program so far, 1/3rd of the patients have been able to go home the next day and the majority are discharged 2 days following surgery. Only a few have required longer hospitalization. Patients are seen in the office 7-10 days following the procedure to check the incisions and remove the catheter. Kegel exercises are then started, to help rehabilitate the urinary sphincter to regain normal urinary control. Many patients are driving by 2 weeks and are able to return to work. For patients with a more physical job, it is necessary to remain off of work for 4 weeks.

RISKS AND COMPLICATIONS
Although operative times are generally longer with Robotic Prostatectomy, overall hospital stay and blood loss are less than with conventional radical prostatectomy. Complication rates are generally the same with both procedures.

Radical robotic prostatectomy is a cutting edge technology that utilizes the power of computers to assist the surgeon's skill. The procedure provides excellent surgical results with complete removal of the cancer, while minimizing lengthy incisions and improving postoperative recovery. The improved visualization and instrument control minimizes the risk of complications. Robotic Prostatectomy is a new advance in medical technology that is enabling cancer patients to go on to live active and productive lives sooner after their treatment and with fewer side effects.