About Robotic Prostatectomy
Prostate cancer, a malignancy that develops in the prostate gland, is often treated successfully in its early stages with surgery. Surgeons who treat prostate cancer have 3 goals:
1) eradicating the patient's cancer
2) preserving the structures that help maintain urinary continence
3) safeguarding the nerves that provide sexual function
Robotic surgery allows for the surgeon to achieve these 3 goals in addition to one very important other goal:
- Speed a patient’s recovery using a minimally invasive approach
Robotic prostatectomy is also known as robot-assisted laparoscopic prostatectomy. This treatment for prostate cancer takes all the knowledge about anatomy and open surgery to the 21st century. It is the most advanced treatment option for patients who are candidates for surgery. Operating through six tiny holes in the abdomen, surgeons remove the cancerous tissue while preserving the vital nerves and arteries that control bladder and sexual function. This nerve sparing prostatectomy approach helps men retain their urinary control and sexual function.
In the hands of an experienced robotic surgeon, robotic prostatectomy offers patients a shorter hospital stay, less blood loss, significantly less pain, a faster recovery, improved urinary continence and sexual function, less scarring, and excellent clinical outcomes.
The Robotic Surgery Program at Stony Brook Hospital is led by urologists fellowship trained in both urologic oncology (the surgical treatment of urologic cancers) and robotic surgery.
Robotic Prostatectomy with the da Vinci Robot
Surgeons here perform minimally invasive robotic prostatectomy using the da Vinci Surgical System. In experienced hands, the da Vinci is a safe way to provide the highest level of surgical quality. Urologists have been using the da Vinci longer than other specialties and robotic prostate surgery is proven to be safe. With da Vinci prostate surgery, miniaturized surgical instruments enable surgeons to manipulate tissue with great accuracy and remove the patient's prostate gland while minimizing harm to the surrounding tissues. Da Vinci prostate surgery provides surgeons with significantly enhanced magnification of the surgical field to help preserve the important nerves that run alongside the prostate, reducing the risk of urinary incontinence and sexual dysfunction.
Robotic Prostatectomy and Cancer Control
The enhanced visualization with the robot allows for the surgeon to maximize the chance of seeing cancer outside the prostate and removing the cancerous tissue. In addition, we often send specimens from around the prostate to help ensure the surgical margins are free of tumor. In addition, we often remove the lymph nodes to diagnose if the cancer has spread and help remove all the cancer from the body.
Urinary Continence after Robotic Surgery
We take a more advanced approach to preserving urinary function. Instead of removing the attachments of the prostate to other pelvic structures, the urologic surgeons at Stony Brook Medicine can save the endopelvic fascia and puboprostatic ligaments. It is believed that important nerves may run through the endopelvic fascia, and these are preserved. In addition, we perform bladder neck sparing. The bladder neck contains one of the “valves” that helps keep men from leaking urine without having to think about it or perform a “Kegel maneuver” to stop their urine flow. The combination of saving the bladder neck and the prostatic ligaments often results in men who regain their urinary control immediately or very soon after the urinary catheter is removed. This is paramount in helping men return to their pre-surgical state quickly and maintain quality of life and an active lifestyle.
Sexual Function After Nerve Sparing Robotic Prostatectomy
Recovery of sexual function after robotic prostatectomy varies from man to man. In men who are healthy with good sexual function before surgery, when the nerves are spared sexual function often returns within the first year. In men with high risk cancer, we can obtain an MRI to evaluate if the prostate cancer is stuck to the nerves. This can help us to save more of the nerve tissue with the operation while maintaining cancer control.
Recovery
Most patients who undergo a nerve sparing robotic prostatectomy procedure spend only one night in the hospital and go home the next day. The re-approximation of the bladder to the urethra is so good with robotic surgery that often times a drain does not need to be left. This is opposed to traditional open surgery where a drain was always left. Robotic prostatectomy patients – in general - have a fast recovery. We make sure our patients are walking the day of their surgery to help get them on the road to recovery and prevent blood clots from forming in the legs. Because of their low blood loss and tiny their incisions, which cause minimal pain, many patients feel great shortly after surgery.
Major steps during robotic prostatectomy
Preserved nerves that control erections (red line)
Controlling blood vessels (yellow line)
Foley catheter that stays in bladder for 1 week to allow healing (blue line)
Preserved nerves that control erections (red line)
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