How is robotic prostatectomy performed

Performing the Robotic Prostatectomy: A Prostate Cancer Surgery General Overview for Patients The essence of minimally invasive prostate cancer surgery is to gain access to the involved anatomy via the smallest entry points possible.

Traditional open prostatectomies involved cutting open the lower abdomen with a large incision. Predictably, large incisions in traditional surgery for prostate cancer run a higher risk of infection and require significantly more time for the patient to heal, not to mention they tend to leave a large scar.

Laparoscopic techniques however, using the da Vinci Robot, bypass this large incision and gain the same access through a few small holes in the skin, each roughly the size of a dime. A small plastic tube known as a "port" is inserted in each hole to keep a channel open for laparoscopic Port Placement image tools to reach through.

To allow room inside for the surgeon to work, the abdomen is inflated slightly with carbon dioxide like a balloon.

In this working space, the surgeon can perform the same surgeries as if the abdomen had actually been cut open, but without the large incision. Through one of these ports a laparoscope, essentially a very small telescope with a camera attached, is passed to allow the surgeon to see inside the abdomen. This is how traditional laparoscopic procedures have proceeded and the techniques are Robot Placement image very well proven and refined.

However, in the robotic prostatectomy, instead of proceeding with laparoscopic hand tools and holding the laparoscope by hand, the da Vinci Surgical system is employed. Miniature robot arms and a robotic laparoscope are passed through the ports. These arms and camera are then operated by the surgeon at a remote console. The surgeon then proceeds to dissect out the prostate using the da Vinci Surgeon Console image system.

The da Vinci system includes a great number of robotic tools that can be swapped in and out on each arm as needed such that the surgeon has every tool he needs. Robotic prostatectomy is a minimally invasive procedure performed by an experienced laparoscopic surgery team with the assistance of advanced surgical technology.

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 e.

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. Compared with traditional open surgery, patients who undergo robotic-assisted radical prostatectomy experience:.

Faster recovery times although catheter needs to remain in bladder for same amount of time after robotic or open procedure. Pelvic lymph nodes that may be involved by cancer are removed when indicated to better stage the extent of tumor involvement.

Lastly the bladder is sewn back to the urethra to restore continuity of the urinary tract. Thermal energy is minimized during dissection of the prostate so as to avoid injury to the delicate nerve fibers and muscles involved in penile erections and urinary control. Once the prostate and lymph nodes are removed, they are immediately placed within a plastic sack which is later removed intact at the end of the operation through an extension of one of the existing abdominal incision sites.

A small drain is left at the end of the procedure exiting one of the keyhole incisions along with a urethral catheter called foley , which is used to bridge the connection created between the bladder and urethra called the anastomosis. Finally the specimens are removed from the abdomen through the plastic entrapment sack and the skin incisions closed using plastic surgery techniques to minimize scarring.

Abdominal incisions at one month following surgery are generally barely visible. The following is a slide show of a series of schematic drawings to help patients better understand the steps involved with nerve-sparing robotic prostatectomy. Although most patients experience some degree of urinary leakage i. Comparison of outcomes between pure laparoscopic vs robot-assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes.

Br J Urol Int , Return of sexual function following nerve-sparing robotic prostatectomy is more challenging to define and assess as results depend on multiple factors including patient age, preoperative sexual function, percent of nerves spared during surgery, recovery time after surgery and presence of pre-existing medical conditions such as hypertension, heart disease, diabetes, obesity, smoking and high cholesterol.

Viagra, Cialis, Levitra at 3, 6, and 12 months postoperatively. Comparison of outcomes between purle laparoscopic vs robot-assisted laparoscopic radical prostatectomy: a study of comparative effectiveness based upon validated quality of life outcomes. As with any major surgery, complications, although rare, may occur with robotic prostatectomy.