Robotic Radical Prostatectomy offers a chance to control prostate cancer while minimizing the side effects of surgery. The DaVinci Robot is a surgical tool which provides the surgeon with the ability to operate within the body through small incisions in the abdomen.
Robotic Surgical Team
Robotic Prostatectomy achieves the same goals as traditional open surgery.
- The prostate and tumor can be removed in its entirety.
- Nerves and arteries to the penis which run closely adherent to the prostate can be preserved, or sacrificed, depending on the goals of the surgery.
- The robot can help visualize and preserve structures necessary to prevent the leakage of urine.
Increased Surgical Precision
- Small, dexterous instruments, with can assist with dissection, the gentle handling of tissues, and the repair of the bladder neck through:
- computer assisted tremor reduction
- the ability to scale down movements until they are incredibly precise
- instruments are smaller than the human hand and can move easily in tight spaces
“Wristed Instruments”
the robotic arm holds instruments which allow movements which mirror the motions of the human hand- Sewing inside the body with this instrument is much easier. The bladder neck and urethra can be connected with a watertight running stitch instead of the traditional interrupted sutures, which are tied down blindly using the open technique.
Increased Visualization
Binocular Lenses Provide Depth Perception
- There is better visualization of the entire operation due to markedly decreased blood loss, and the properties of the robotic scope:
- The instrument has the ability to “fly down” to within millimeters of important structures,
- The Robot has the ability to see around corners with angled scopes, and to magnify structures.
- The Robot provides a three dimensional view which allows depth perception.
The operating field is illuminated by powerful fiberoptic lights, which are not blocked by the surgeon’s hands or the assistant’s head.- The surgeon sits comfortably at the surgical console, resting his arms on an armrest.
Open Surgical Technique
This must be contrasted with the open technique. Using traditional open technique, a lower abdominal incision forces the surgical team to look at angle under overhanging pubic bone. The surgeons must constantly adjust the position of lights, their hands and their surgical instruments to enable them to both operate and to see what they are doing. Often, a surgeon’s head blocks the light; sometimes headlights are worn. Many surgeons wear glasses fitted with magnifying lenses. Typically, only the primary surgeon has an unobstructed view. There is more bleeding during the open technique because the pressurized abdomen used in the robotic technique stops the low pressure oozing from veins in the pelvis. The surgeons must constantly remove the blood from the pelvis in order to see what they are doing. A well trained surgical team can overcome these obstacles, but they are consistently present.
Robotic Prostatectomy In Perspective
Dr. Nobert
The Surgeon Sits at a Console Near the Patient
Are there difficulties inherent in Laparoscopic or Robotic Surgery which are different from those in open technique? Yes. Laparoscopic skill is specialized skill that is developed in addition to good open technique. These skills are best achieved through mentorship with a skilled surgeon, just as all surgical skills are. This is the purpose of surgical training programs. There are currently many open surgeons who have years of experience and are reluctant to spend time training to use laparoscopic technique or to use the robot.
An Assistant Surgeon Tends the Robotic Arms at the Bedside
There are also training programs which are struggling to teach their surgeons proper open technique due to a decrease in the volume open cases. It is important to find a surgeon who is comfortable and experienced with both Open and Robotic techniques. I was lucky to be trained at a busy institution where our open surgical volume for prostate cancer surgery was higher than 95% of training programs. This was at a time when Robotic Surgery was just coming in to being, and I helped develop it at the institution where I trained, and later brought it to St. Lukes-Roosevelt Hospital, where we have performed it for many years. If find the robot to be an elegant instrument for performing cancer surgery which is faithful to the surgical principles of the greatest open surgeons.
To Compare the Different Techniques of Prostate Cancer Surgery, Click Here