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Robotic Prostate Cancer Surgery
DaVinci Robotic Prostatectomy

Comprehensive Urology prides ourselves on providing our patients with the best and most effective prostate cancer treatment in Los Angeles. The da Vinci Robotic Prostatectomy is an advanced robotic surgery for whole-gland treatment.

The da Vinci Robotic Prostatectomy is the most advanced surgical means of treating prostate cancer. Robotic surgery in expert hands has been shown to produce excellent outcomes.

Our robotic urologic surgeons in are leading robotic surgery experts with over 1,000 surgeries provided to date. The da Vinci robotic surgery is one of the many states of the art technologies used at Comprehensive Urology of LA to provide minimally invasive custom tailored therapies for outpatients.

A da Vinci robotic prostatectomy undoubtedly enhances the outcomes for our patients. Our surgeons are able to perform custom-tailored operations to address individual needs based on all prior findings such as dynamic MRI fusion studies, etc.

Using the results, your surgeons have more insight as to whether or not the cancer is involving the very fine nerves responsible for erectile function and continence, which run close by the outer surface of the prostate.

By having this information, our surgeons can judiciously determine an optimal surgical approach (nerve sparing versus non-nerve-sparing approaches or modifications based on each individual case’s needs and extent of disease).

The Comprehensive Urology team performs an in-depth prostate cancer evaluation prior to recommending robotic surgery. We want to learn about our patients, their prostate cancer extent, and their treatment goals so we can provide them with the optimal treatment. After we conduct a comprehensive patient evaluation, we will provide prostate cancer treatment recommendations. If we determine a patient is a suitable candidate for robotic prostatectomy, we will then discuss and that individual’s treatment concerns and questions. By doing so, we will help a patient make an informed prostate cancer treatment decision.

How does the DaVinci System work for Robotic a Prostatectomy?

The da Vinci System allows a surgeon to use robotic instruments to perform a prostatectomy (surgical removal of the prostate gland) safely. At the same time, the da Vinci System helps enhance prostate cancer patient recovery and outcome.

The da Vinci System ensures a surgeon can administer a prostate cancer treatment in approximately three hours, which is comparable to the amount of time it takes to perform a traditional open prostatectomy. During a robotic surgery, a surgeon is in control of the da Vinci System at all times. He or she uses a surgical console to control high-resolution cameras and microsurgical instruments to perform the procedure. The da Vinci System ensures the surgeon’s hand movements are scaled, filtered, and seamlessly transferred into precise movement of the system’s EndoWrist instruments. These instruments can be turned in all directions with 90 degrees of articulation and 7 degrees of freedom.

The da Vinci System also provides a surgeon with enhanced visualization, dexterity, and precision in comparison to traditional open or laparoscopic surgery. The system ensures a surgeon can make small incisions (2 cm or less) and perform careful movements. This helps minimize the risk of damaging a patient’s prostate nerves that control the bladder and sexual function.

Types of Robotic Prostate Surgeries

The da Vinci robotic surgical system and similar robotic devices can be used to perform a variety of complex but minimally invasive operations, including these two common procedures for prostate conditions.

Robotic-Assisted Laparoscopic Prostatectomy (RALP)

Due to its safety and efficiency, robotic-assisted laparoscopic radical prostatectomy has become the most commonly used approach for surgically treating prostate cancer for about a decade or so. The da Vinci procedure is particularly ideal for minimally invasive prostate surgery as the surgeon has such a high degree of control and precision that it is possible to protect vital nerves, also magnified 3-dimensional views, ensuring precise surgery that enables patients to typically maintain normal sexual and voiding activity relatively sooner after the surgery.

RALP involves only six small incisions of no larger than 1.5 centimeters, through which the surgeon will be able to dissect and remove the prostate, then suture (sew) the urethra back to the bladder without the surgeon’s hands ever having to enter the body. In some cases, depending on the patient’s condition, the pelvic lymph nodes may also be removed to assess for involvement by metastatic cancer.

Robotic-Assisted Surgery for Benign Prostatic Hyperplasia (BPH)

For patients with benign prostatic hyperplasia which causes bothersome urinary issues, it is possible to remove portions of the enlarged prostate with minimally invasive da Vinci robotic-assisted surgery. This option is called robotic “simple” prostatectomy and typically recommended after other procedures have proven ineffective or for patients who have severely enlarged prostate due to BPH.

The placement of the incisions in the robot-assisted procedure will depend on the extent of the prostate size as well as the patient’s symptoms and overall health. The surgeon will make precise incisions in the prostate to remove abnormally enlarged inner portions that block the urethra and then repair the gland back together.

Da Vinci Robotic Prostatectomy Procedure step by step.

 

Step 1. Patient Setup and Anesthesia

Our patient is brought into the operating room where anesthesiologists and the rest of our team members greet them. Our patient then undergoes anesthesia and is positioned for the robotic prostatectomy procedure. Subsequently, six incisions measuring approximately 1 cm (half an inch) in size each are placed in the abdomen as illustrated below. Through each port, a trocar is placed, which allows instruments to be placed into and removed from the abdominal cavity. This is how laparoscopic and robotic operations are performed. The fact that smaller incisions are necessary for the procedure is only one of the many advantages of the robotic prostatectomy operation as compared to the standard open approach.

Step 2. Dissection of the seminal vesicles

The first step of robotic prostatectomy is the dissection of the seminal vesicles often the adjoining tissue to allow them to be removed with the prostate as a unit.

Step 3. A release of the bladder

The bladder is subsequently released from the connective tissue in the pelvis, allowing exposure to the endo-pelvic fascia and ultimately the prostate

Step 4. Incision of the endo-pelvic fascia

By incising the endo-pelvic fascia, access is gained to the entire prostate and to the urethra.

Step 5. Control of dorsal venous complex

The dorsal venous complex is a large vein that runs on top of the prostate. Controlling it is one of the key steps to being able to free the prostate for removal. This step is elegantly performed with the use of a special surgical stapling device that staples and cuts the dorsal vein in one step. The result is outstanding with very little blood loss.

Step 6. Bladder neck dissection

The next step is freeing the prostate from the bladder. This is a critical step in the procedure. There are two urinary sphincters (round muscles that can squeeze down and keep the urine from leaking out of the urinary tract) in the male urinary tract. One sphincter is at the neck of the bladder as it joins the prostate, and the second is located around the urethra just below the prostate. Preservation of both of these sphincters aids in the recovery of urinary control in patients undergoing a robotic prostate surgery. Therefore, meticulous technique is used to preserve both the bladder neck as well as the urethral sphincter during the operation.

Step 7. Preservation of nerves for erections

In experienced hands, preservation of the nerves that control erections is relatively straightforward. The nerves are attached to and wrap somewhat around the prostate gland, and with meticulous dissection, they can be easily freed completely from the prostate. During this portion of the operation, great attention is paid to minimize any tension on the nerves. Electrocautery is also strictly avoided to ensure that no nerve damage occurs.

Step 8. Separating the prostate from the urethra

Once the prostate has been freed inferiorly from the rectum, superiorly from the bladder, and laterally from the nerves, then only the attachment to the urethra remains. By separating the prostate from the urethra, the prostate will now be completely freed and can be removed safely. During the separation of the prostate from the urethra, great care is given to preserving the urethral sphincter which is critical for preserving a man’s urinary control.

Step 9. Removal of the pelvic lymph nodes

During a robotic prostatectomy, the pelvic lymph nodes that can be seeded by cancer cells from the prostate are removed for sampling. This information helps us determine if any evidence of microscopic disease has spread beyond the prostate. The lymph nodes are nestled superiorly by the iliac vein and artery and inferiorly by the obturator nerve. Meticulous technique is used to preserve all of these structures during the left node removal.

Step 10. Connecting the bladder neck to the urethra

After removal of the prostate, the bladder neck is sutured to the urethra. This is performed in such a fashion that the closure is watertight. The watertight anastomosis allows the urethral catheter to be removed earlier and ensures better healing of the bladder neck and urethral tissues.

Step 11. Removal of the prostate

After removing the prostate from the surrounding vital tissues, the prostate is placed into a specimen bag inserted inside the patient’s abdomen through one of the ports, which is retrieved at the end of the procedure through one of the incisions (above umbilicus) which will be made slightly larger. All incision sites are subsequently closed and our patient is soon awakened from anesthesia and safely transferred to the recovery room.

As with any surgical procedure, there are risks associated with robotic-assisted prostate surgery, which our team, the urologists at Comprehensive Urology in Los Angeles discuss with each and every patient. It is our highest priority to deliver the best quality care possible while also ensuring that our patients are well-informed and confident in their care.

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FAQ

Why do patients choose Robotic Prostate Surgery?

There are many reasons why patients frequently select robotic prostate cancer surgery over traditional treatment options, and these reasons include:

  • Short Hospital Stay: Most da Vinci robot prostatectomy patients return home the same day as surgery.
  • Minimal Pain: Oftentimes, robotic prostate cancer surgery patients experience less pain than they would during a traditional open prostatectomy.
  • Reduced Risk of Complications: The da Vinci System ensures a surgeon can perform accurate, precise movements, thereby reducing the risk of potential complications such as bleeding also urinary incontinence or impotence.
Am I a candidate?

In most instances, men who are diagnosed with a localized prostate cancer are ideal candidates for robotic surgery. Additionally, most patients who are candidates for traditional open prostate cancer surgery are also candidates for a robotic prostatectomy procedure.

The Comprehensive Urology team performs an in-depth prostate cancer evaluation prior to recommending robotic surgery. We want to learn about our patients, their prostate cancer extent, and their treatment goals so we can provide them with the optimal treatment. After we conduct a comprehensive patient evaluation, we will provide prostate cancer treatment recommendations. If we determine a patient is a suitable candidate for robotic prostatectomy, we will then discuss and that individual’s treatment concerns and questions. By doing so, we will help a patient make an informed prostate cancer treatment decision.

Recovery from Robotic Surgery?

After recovery from the anesthesia, our patients are transferred to a private room. The hospital stay for our patients is typically one or two nights at the prestigious Cedars-Sinai medical center. Within the first day of a robotic surgery for prostate cancer, our patients are able to and are requested to, start walking.

They are started on an oral diet on the first day of their operation as well. The typical recovery from a robotic prostate surgery for prostate cancer performed by the surgeons at Comprehensive Urology is excellent. The majority of our patients go back to work within one to two weeks from the time of their operation.

Robotic Prostate Surgery vs. Traditional

Unlike traditional surgery, the da Vinci surgical system is minimally-invasive as it needs only small incisions in which to operate. The high-resolution 3D endoscope and high-intensity illuminators offer high definition images for superior visualization, which greatly improve the surgeon’s ability to target malignant or targeted tissue, leaving surrounding muscle, tissue, and organs untouched.

Additional benefits of the minimally invasive da Vinci robotic-assisted surgery compared to traditional open surgery include:

  • Smaller incisions
  • Minimal scarring
  • Improved preservation of healthy tissue and nerves
  • Less postoperative pain
  • Shorter hospital stay and recovery time
  • Less blood loss
Da Vinci Surgical System for Prostate Cancer

The minimally invasive da Vinci robotic prostate cancer surgery system uses cutting-edge technology to improve upon traditional open surgery techniques. The surgeon completely controls four interactive robotic arms from a computer console, which allows the surgeon to perform minimally invasive complex operations with precision and accuracy.

The da Vinci Surgical System received FDA approval in 2000 for both adult and pediatric urologic procedures, among others. The system is designed to perform the same movements of the surgeon’s hands, fingers, and wrists without the need for large incisions. The instrument arms are able to operate in 1-cm openings or operating ports in the patient’s abdomen for minimally invasive procedures.

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