Radical Prostatectomy via da Vinci Robotic Surgery
While there are several treatment options for prostate cancer, there is reasonable data showing that surgical removal of the prostate is superior to a watchful waiting approach in terms of disease specific mortality, overall mortality, the occurrence of distant metastasis and local progression.
Among patients treated with radical prostatectomy, the disease specific mortality (ie. the percentage of patients who actually died of prostate cancer) was 9.6 compared to 14.9% of patients treated managed with watchful waiting. Among patients who underwent surgery to remove the prostate, 20% died of prostate cancer (overall mortality) vs. 32% of patients undergoing watchful waiting. 15.2% of patients after prostatectomy suffered distant metastasis vs. 25.4% managed with watchful waiting and 19.2% of patient’s experienced local progression of their prostate cancer after surgical removal vs. 44.3% after watchful waiting. These data indicate that among men with over ten year life expectancy it is reasonable to consider the removal of the prostate at the time of diagnosis.
da Vinci Prostatectomy Incision vs. Traditional Prostate Surgery Incision
Robot-assisted radical prostatectomy (removal of prostate) is becoming the gold standard for treating organ confined prostate cancer. The illustration above shows one reason why: a traditional (open) prostatectomy leaves a significant size scar below the naval (shown on left). Using the da Vinci robot, the surgeon makes a series of tiny incisions (shown on right). There are numerous advantages to a robotic laparasopic prostatectomy.
Robotic Surgery and Prostate Cancer Treatment
Surgery to remove the prostate may be performed in two fundamental ways, either through a larger incision (opens surgery) or using a laparoscopic/robotic approach. With laparoscopy, small “band-aid” incisions (“ports” approximately ¼ inch in length) are made in the abdomen. Surgical telescopes and robotic and laparoscopic instruments are used through these small ports to remove the prostate and reconstruct the urinary tract. Regardless of the surgical approach, fundamentally the same operation is done whereby the prostate, seminal vesicles, and lymph nodes (if necessary) are removed and then the bladder neck and urethra (with the urinary sphincter muscle) are reconstructed.
Open surgery has become a less common approach. Many patients see the advantages of the robotic approach given the quicker recovery, and the application of advance technology with its attendant advantages.
Why is Robotic Surgery Better for Treating Prostate Cancer?
The robotic approach is becoming most common in the United States given that it is a minimally invasive application of advance technology. Just with other computer and video assisted technologies, there have been dramatic advancements over the past decade and these have translated into some marked improvements in surgical technology.
With the robotic approach, many experts believe that we are able to do a better job given the improved vision and the dexterity of the DaVinci robotic instruments. Delicate structure such as the neurovascular bundle, the bladder neck and urethra are able to be well seen and manipulated gently using small robotic instruments with minimal blood loss. In addition, robotic and laparoscopic procedures entail filling the abdomen with air (a so-called pneumoperitoneum) which acts to decrease bleeding by putting some back pressure on small blood vessels during the surgery. This improves surgical vision dramatically so that a better job can be done preserving the delicate structures.
Comparing Surgical Options
Let's look at a comparison of retropubic prostatectomy, laparoscopic prostatectomy and robot assisted radical prostatectomy:
In a recent study, medical centers were compared which had an established program treating prostate cancer in relatively high volume over the past 15 years. Both the perioperative outcomes, positive surgical margins, and functional outcomes such as urinary incontinence and erectile dysfunction were compared following these three treatments.
While this study does not represent a randomized trial (and therefore maybe criticized) there were significant advantages with the robotic approach. For example, the operative and postoperative transfusion rates where 1.4% for the robotic approach compared with 3.5 and 20.1% for the laparoscopic and open radical prostatectomy approaches, respectively. The rate of positive surgical margin (which means that tumor was at the margin of the prostate, increasing the chance of recurrent prostate cancer following treatment) was also lower among patients treated with robot assisted radical prostatectomy. The overall positive surgical margin rate among these patients was 13.6% compared 21.3 and 24% among the laparoscopic and open radical prostatectomy groups, respectively.
|Type of Prostatectomy||Open||Laparoscopic||dVP|
|Operative Time (Min.)||164||248||140|
|Blood Loss (mL)||900||380||<100|
Improved Continence with DaVinci Robotic Surgery
Similarly, continence rates were higher among the DaVinci robot assisted radical prostatectomy group at 92% 12 months following the procedure compared to 79 and 84.8% for radical prostatectomy and laparoscopic prostatectomy, respectively.
Less Chance of Impotence/Erectile Dysfunction with Robotic Surgery
The likelihood of erectile function at 12 month following surgery also was superior for the robotic group. Patients who underwent a unilateral or bilateral nerve-sparing procedure had a 59.9% and 93.5% chance of erectile function following the DaVinci robotic assisted approach compared to 43.1 and 60.6% for the open radical prostatectomy patients. Patients who underwent a laparoscopic radical prostatectomy had a 31% potency rate if they had unilateral nerve preservation, and 54% if they have a bilateral nerve sparing prostatectomy performed. (Reference: Journal of EndoUrology October 13, 2010, Coelho Rf, et. al).
About Robotic Surgery with the da Vinci Surgical System at CPMC San Francisco
San Francisco residents as well as people who come from all over the United States know that CPMC’s top surgeons are among the best in the San Francisco Bay area at performing da Vinci Robot-assisted surgeries. In fact, CPMC’s gynecologists perform more da Vinci Robot-assisted surgeries than any other San Francisco Bay Area doctors. Robotic surgery such as the da Vinci surgical system is now the gold standard of treatment for many conditions. Our commitment is to be one of the best robotic and da Vinci surgery centers in the San Francisco Bay Area, in California, and in the United States and to work with our patients to determine the best treatment options, including minimally invasive robotic surgery using the top-rated da Vinci robot. Our Robotic Surgery Department serves the entire San Francisco Bay Area, including San Francisco and Marin County, as well as the entire Northern California region with da Vinci certified surgeons.
Note: da Vinci takes its name from Leonardo di ser Piero da Vinci the famous Italian artist and scientist. “da Vinci” may be misspelled as one word, daVinci, as in daVinci robotic surgery, or daVinci surgery, or daVinci certified surgeon, but the correct spelling is two words, da Vinci.