da Vinci Robot Assisted Suprapubic Prostatectomy

What is da Vinci Robot Assisted Suprapubic Prostatectomy?

The da Vinci Robot Assisted Suprapubic Prostatectomy is a surgical procedure which removes part of the prostate called the prostatic adenoma, which can cause obstructive symptoms in men. Dr. Kamyar Ebrahimi, who is a fellow ship trained urologist practicing in Glendale CA, and an expert in performing this procedure, explains: da Vinci Robot Assisted Suprapubic Prostatectomy is performed on patients whose prostate is larger than ones that could be treated with laser or the traditional TURP.

What are the risks of da Vinci Robot Assisted Suprapubic Prostatectomy?

Some of the risks of da Vinci Robot Assisted Suprapubic Prostatectomy are similar to that of the open Suprapubic Prostatectomy, says Dr. Ebrahimi, who has performed many of these procedures. These risks are bleeding, infection, and the risk of anesthesia which includes risk of heart attack, stroke and death. It is important to mention that the robotic approach is not without complications, especially as the surgeon is negotiating the learning curve. This is where formal fellowship training or years of experience with the procedure can secure an excellent outcome.

What are the advantages of da Vinci Robot Assisted Suprapubic Prostatectomy?

The use of the da Vinci Surgical System is an effective tool for minimally invasive surgery in the hands of the trained urologist. This approach allows for removal of the adenoma, and good control of bleeding. The proven advantages are faster recovery and return to normal activity, less pain and bleeding, shorter hospital stay, smaller incisional scars, less risk of wound infection.

What is the da Vinci Robot?

Developed in the early 2000’s, the da Vinci robotic surgical platform is a machine which facilitates the performance of surgery through small “key-hole” incisions. Dr. Kamyar Ebrahimi a fellowship trained and published urologist with special expertise in using the da Vinci robotic system explains that the “da Vinci robotic system has two components: a patient cart (where the patient is operated on and where the robot actually interacts with the patient) and a surgeon console (where the urologist controls the robotic instruments inside the patient). The da Vinci robotic surgery has other names such as Robot assisted surgery, Robotic assisted laparoscopic surgery, Laparoscopic surgery with robotic assistance. Essentially, the da Vinci robotic becomes an interface, a facilitator of sorts, between the patient and the doctor, allowing the surgeon to be able to use all of the dexterities of his/her hand in the patient, without actually having his/her hands inside the patient.

What are some of the advantages of the da Vinci robot?

The innovations of da Vinci robotic surgical platform bring several advantages for the surgeon and the patient to the surgery. For the urologists in particular, these novel improvements include the ability to have a three dimensional view of the anatomy, the ability to move the instruments in an intuitive fashion (i.e. when the surgeon wishes to move an instrument to the right, he or she does so by moving his or her hand to the right) much like in open surgery. Furthermore, the tiny instruments of the robotic system have all the degrees of freedom similar to the human hand.

For the patient, decreased bleeding, shorter hospital stay, decreased pain, smaller incisions enabling faster recovery. Nonetheless, improved cancer control, urinary continence and erectile function have not materialized in the literature. This has many reasons, and may experts believe that the comparisons between open surgery and robotic surgery should not be done with the current data, which for the most part includes a robotic surgeon’s experience during his or her learning curve (the period of time where the urologist is learning the procedure and getting comfortable with the approach, which is between 50-200 cases). Some consider the comparison between mature surgeons performing open prostatectomies to novice surgeons negotiating their robotic “LEARNING CURVE” to be unfair, and one of the reasons why robotic prostatectomy has not “reached its true potential” in achieving these goals.

This illustrates the crucial importance of training. Studies indicate that the number of cases required during the learning curve is somewhere around 50 for individual surgeons; while some experts believe that is as high as 200, akin to the open surgical approach.