What is da Vinci Robot Assisted Radical Prostatectomy?

The da Vinci Robot Assisted Radical Prostatectomy is a surgical procedure which removes the entire prostate gland and seminal vesicles for the treatment of prostate cancer. Over 70 percent of patients with prostate cancer have their prostate removed with the da Vinci Robot. The goal of this operation is to achieve the “Trifecta” of undetectable PSA, return of sexual function to pre-surgery status, and return of urinary continence.

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

It is important to mention that the robotic approach is not without complications, especially as the surgeon is negotiating the learning curve. Some of the risks of da Vinci Robot Assisted Radical Prostatectomy are similar to that of the open radical prostatectomy. These risks are bleeding, infection, urinary incontinence and erectile dysfunction. There is also the risk of anesthesia which includes risk of heart attack, stroke and death. 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 Radical Prostatectomy?

The use of the da Vinci Surgical System as an effective tool for minimally invasive surgery by many, yet individual results may vary. some individuals may be candidates for a full nerve-sparing procedure and this can be facilitated by the machine much more easily. However the surgeon must be skilled in recognizing the structures and spare these nerves when possible. 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.

What To Ask When Considering Robotic Surgery For Prostate Cancer?

The world of medicine has changed significantly in the last decade. In the fields of urology and gynecology to be specific, the development of robotically assisted surgery using the da Vinci Surgical Platform has allowed surgeons to perform major procedures through small key-hole incisions, offering patients faster recovery, less blood loss, and the potential for better outcomes after the surgery, as compared with the traditional open approach. But, what should the patient consider before deciding on this type of surgery?

Firstly, it is always a good idea to get a second opinion regarding the diagnosis, and to make sure that proceeding with a robotically assisted surgery in one’s particular case is the best approach. Next, make sure that the facility has the right equipment for the job. So, ask about the type and model of the robot that is being used, and whether the personnel in the hospital know how to treat such patients. Next, always ask about the potential complications for the surgery, and what to expect and watch-out for in the recovery period. Remember, just because you had a “minimally invasive surgery,” and should have “less pain” than open surgery, it does not mean that your surgery would not be “pain-free.” This way, your expectations as a patient are well-formed because you are well-informed, and will not be met with disappointments. Lastly, and perhaps most importantly, ask your surgeon about his or her experience with using the robot. Since the robot has been around for several years, there are formal training centers where surgeons can learn this new technique, either integrated during their residency training (some as long as 6 years), or extra as part of a fellowship (ranging between 1-3 years). Some of the latest literature suggests the need for at least 50 cases before most surgeons are comfortable with the new approach, advocating a rigorous training and that perhaps the old adage in medicine: “see one, do one, teach one” does not apply in this particular situation.

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