Surgical Treatment of Prostate Cancer
For treatment of prostate cancer, robotic surgery is quickly becoming the standard, nationwide and here locally. In fact, it is estimated that more than half of all radical prostatectomies done this year will be performed with the da Vinci™ robot.
Doing a standard laparoscopic surgery without robotic assistance requires using straight, rigid instruments, and limits the surgeon’s view of the operating field to a two-dimensional screen. With the robotic system, hinged wrist movements more closely mimic a human wrist’s maneuverability, and the surgeon views a magnified operating field in 3-D and high definition.
Not everybody is a candidate for robotic prostatectomy. A traditional open surgery is usually performed on men whose cancer is more advanced, those who are obese, and people who have had several prior surgeries, because intra-abdominal adhesions make the robotic procedure more difficult.
Fortunately, however, the vast majority of patients are candidates for robotic surgery.
Surgeons say the greatest advantage for them is use of the da Vinci™ system’s EndoWrist. It allows them “seven degrees of freedom” – the ability to move up, down, backward and forward, plus rotate in ways traditional laparoscopes cannot.
“I can get into very tight, confined spaces and twist these instruments,” explains David Mikkelsen, MD, who has been using the da Vinci system since 2004. “I have much better mobility and dexterity.”
And that, he says, helps accomplish two important things: “It saves the nerves the patient will need to have an erection, and preserves the sphincter muscle which is responsible for continence.”
Erectile dysfunction (ED) and incontinence are side effects men may experience, regardless of the kind of treatment they undergo. Because robotic surgery is still relatively new, researchers are just beginning to obtain and review validated questionnaires to show whether this form of treatment offers a shorter duration of the side effects.
“I think we’re going to find that ED may be improved with robotic surgery,” says Dr. Mikkelsen.
Other urologic conditions treated with the robot include ureteral pelvic junction obstruction (commonly known as UPJs) and pyeloplasty (repair of the connection between the kidney and the ureter). Some surgeons are also doing partial nephrectomies (removal of kidney tumors).
For most patients, a robotic-assisted prostatectomy offers numerous potential benefits over a traditional surgery, including:
- Smaller incisions, less blood loss and minimal scarring
- Shorter hospitalization
- Reduced pain
- Faster recovery times