Robotic Surgery Hotline

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When medication and other non-surgical treatments are either unavailable or cannot relieve symptoms, surgery is the accepted treatment for a broad range of conditions that affect the male reproductive organs and the organs of the urinary tract. These conditions include, but are not limited to, prostate cancer, ureteropelvic junction (UPJ) obstruction, bladder and kidney cancer and vesicoureteral reflux.

Facing any kind of urologic surgery creates a great deal of anxiety for most men. Among the concerns is: “Will my body function normally following surgery?” Traditional open urologic surgery – in which large incisions are made to access the pelvic organs – has been the standard approach when surgery is warranted. Yet common drawbacks of this procedure include significant post-surgical pain, a lengthy recovery and an unpredictable, potentially long-term impact on continence and sexual function.

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Fortunately, less invasive surgical options are available to many patients facing urologic surgery. The most common of these is laparoscopy, which uses small incisions. While laparoscopy can be very effective for many routine procedures, limitations of this technology prevent its use for more complex urologic surgeries.

A new category of surgery, introduced with the development of the da Vinci® Surgical System, is being used by an increasing number of surgeons worldwide for prostatectomy and other urologic procedures.

This minimally invasive approach, using advanced surgical and robotics technologies, is ideal for delicate urologic surgery. This includes prostatectomy, in which the target site is not only tightly confined but also surrounded by nerves affecting urinary control and sexual function. Using da Vinci®, the surgeon has tool designed to spare surrounding nerves, which may enhance both the recovery experience and clinical outcomes.

Prostatectomy

The Condition: Prostate Cancer

The prostate is a walnut-sized gland that is part of the male reproductive system. Its function is to produce a fluid that is part of male ejaculate or semen.

Prostate cancer is a disease in which malignant (cancer) cells form inside the prostate. Worldwide, more than 900,000 men were diagnosed with prostate cancer in 2008, making it the second most common cancer in men behind lung cancer. 1

Widespread screening, early detection and improved treatment have improved prostate cancer survival rates. When found while it is localized or still contained in the gland, 5-year survival approaches 100%. 2

When prostate cancer is detected early, radical prostatectomy – surgical removal of the prostate gland – offers patients a potential cure.3 In fact, according to the American Urological Association’s 2007 Guidelines for the Clinical Management of Prostate Cancer, “The major potential benefit of [radical prostatectomy] is a cancer cure in patients in whom the prostate cancer is truly localized.”3 Treatment options for prostate cancer may include radiation (either external beam or seed implants) or cryotherapy. These treatments work by radiating, burning or freezing the prostate.

However, surgery is the only treatment that actually removes the cancerous prostate from the body. All prostate cancer treatments can affect urinary continence, as well as sexual potency and function. Talk to your doctor about all available treatment options and what to expect before, during and after treatment.

The Treatment: Radical Prostatectomy

Radical prostatectomy is the most common treatment for prostate cancer. Until recently, prostatectomy was usually performed using an 8- to 10-inch incision. This approach commonly resulted in substantial blood loss and a lengthy and uncomfortable recovery.

da Vinci® Prostatectomy

Today, if your doctor recommends surgery to treat your prostate cancer, you may be a candidate for a very effective, minimally invasive procedure called da Vinci® Surgery. This procedure uses technology designed to help the doctor perform precise and less invasive prostate cancer surgery available today.

For most patients, da Vinci® Surgery offers numerous potential benefits over open surgery including:

  • Excellent cancer control
  • Faster return of urinary continence 5,7
  • Faster return of sexual function 5,7
  • Shorter hospital stay 4,5,8,9,10
  • Low level of pain 8
  • Less blood loss and transfusions 4,5,8,9,11,12
  • Lower risk of infection, complications 9,11
  • Faster recovery and return to normal activities 8,10,12

In addition, compared to radiation treatment, prostatectomy offers men with localized prostate cancer improved survival rates.13,14,15 As with any surgical procedure, these benefits cannot be guaranteed as surgery is both patient and procedure specific.

1 W.H.O. Globoscan 2008. Country Fast Stats. http://globocan.iarc.fr/.
2 Jemal A. et al Cancer Statistics 2005. CA cancer J Clin 2005,55:10-30.
3 Prostate cancer clinical guideline update panel. Guideline for the management of clinically localized prostate cancer: 2007 update. Linthicum (MD): American Urological Association Education and Research, Inc. 2007; 82.
4 Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology. 2004 May; 63(5): 819-22.
5 Rocco B, Matei DV, Melegari S, Ospina JC, Mazzoleni F, Errico G, Mastropasqua M, Santoro L, Detti S, de Cobelli O. Robotic vs open prostatectomy in a laparoscopically naive centre: a matched-pair analysis. BJU International. Published Online: 5 May 2009. DOI 10.1111/j.1464-410X.2009.08532.x.
6 Barocas DA, Salem S, Kordan Y, Herrell SD, Chang SS, Clark PE, Davis R, Baumgartner R, Phillips S, Cookson MS, Smith JA Jr. Robotic assisted laparoscopic prostatectomy versus radical retropubic prostatectomy for clinically localized prostate cancer: comparison of short-term biochemical recurrence-free survival. J Urol. 2010 Mar;183(3):990-6. Epub 2010 Jan 18.
7 Ficarra V, Novara G, Fracalanza S, et al. A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. Mar 5 2009;104(4):534-539.
8 Menon M, Tewari A, Baize B, Guillonneau B, Vallancien G. Prospective comparison of radical retropubic prostatectomy and robot-assisted anatomic prostatectomy: the Vattikuti Urology Institute experience. Urology. 2002 Nov;60(5):864-8.v
9 Boris RS, Kaul SA, Sarle RC, Stricker HJ. Radical prostatectomy: a single surgeon comparison of retropubic, perineal, and robotic approaches. Can J Urol. 2007 Jun;14(3):3566-70.
10 Hohwu L, Akre O, Pedersen KV, Jonsson M, Nielsen CV, Gustafsson O. Open retropubic prostatectomy versus robot-assisted laparoscopic prostatectomy: A comparison of length of sick leave. Scand. J. Urol. Nephrol. Apr 7 2009:1-6.
11 Carlsson S, Nilsson AE, Schumacher MC, Jonsson MN, Volz DS, Steineck G, Wiklund PN. Surgery-related complications in 1253 robot-assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology. 2010 May;75(5):1092-7.
12 Miller J, Smith A, Kouba E,Wallen E, Pruthi RS. Prospective evaluation of short-term impact and recovery of health related quality of life in men undergoing robotic assisted laparoscopic radical prostatectomy versus open radical prostatectomy. J Urol. 2007 Sep;178(3 Pt 1):854-8; discussion 859. Epub 2007 Jul 16.
13 Tewari A, Raman JD, Chang P, Rao S, Divine G, Menon M. Long-term survival probability in men with clinically localized prostate cancer treated either conservatively or with definitive treatment (radiotherapy or radical prostatectomy). Urology. 2006 Dec;68(6):1268-74.
14 Cooperberg MR, Vickers AJ, Broering JM, Carroll PR; for the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) Investigators. Comparative risk-adjusted mortality outcomes after primary surgery, radiotherapy, or androgen-deprivation therapy for localized prostate cancer. Cancer. 2010 Aug 5. [Epub ahead of print].
15 Tewari A, Divine G, Chang P, Shemtov MM, Milowsky M, Nanus D, Menon M. Long-term survival in men with high grade prostate cancer: a comparison between conservative treatment, radiation therapy and radical prostatectomy–a propensity scoring approach.J Urol. 2007 Mar;177(3):911-5.