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There are few surgeries that are as delicate as a prostatectomy, the removal of the prostate to treat cancer. Simply put, the prostate isn’t meant to be removed; it sits in a hard-to-reach location within the male urinary/reproductive tract and is surrounded by thousands of gossamer-like nerves that control among other things a man’s erectile function. In addition, the process of removing the prostate can produce incontinence. Needless to say it is critical that the surgery limit the amount of collateral damage to healthy nerves and tissue that surround the organ. That’s why the control and precision afforded by the da Vinci robotic surgery system offers new hope for cancer patients.
The da Vinci system uses robotic arms that hold special surgical instruments. These instruments are inserted into small incisions made in the abdomen. A lighted scope is inserted into one incison and connected to a camera, providing an excellent three dimensional view of the very small area in which the surgeon must work. This 3D view helps the surgeon find the nerves and muscles surrounding the prostate. The robotic arms that hold the instruments rotate 360 degrees, giving the surgeon flexibility and a level of precision not otherwise attainable. The prostate, lymph nodes, seminal vessicles and surrounding tissues are then removed. Every effort is made to spare surrounding nerves. The entire procedure takes about two to three hours.
There are many advantages to the robotic procedure, including less pain, fewer complications, shorter hospital stay, faster recovery and earlier return of urinary control along with improved sexual function. Most patients will be walking the evening of the surgery and go home the next morning. There will be a catheter in place for about one week. Most patients will resume normal activity in about two weeks. Some patients may experience a return to full bladder control very quickly. Most patients will have a small amount of urinary leakage for two or three months. A smaller percentage may take up to one or two years to regain urinary control. For most patients a normal erection should return within a year. Treatment with medicines, vacuum pumps and penile injections can assist in your return.
We measure a successful surgery the way most men would. First and foremost, we have to remove the cancer. The da Vinci allows us to be more precise in the removal of tissue. While you are in surgery, our pathologist will look at the edges of tissue surrounding your prostate to determine if cancer is present. If cancer is present on the edges, this is called a positive margin. This process gives us the best chance to know if we should remove more tissue. In addition to removing cancer, there are quality of life issues that we include in our definition of success. And we believe that the robotic-assisted approach gives us the best chance to perform nerve-sparing procedure that will give you your best chance of regaining bladder control and sexual function over time.