As technology continues to advance at a rapid rate, both the use of robot-assisted surgery techniques and the number of procedures available is increasing. Expert consultant urologist Mr Omar Al Kadhi explains how robot-assisted techniques can be used in prostate cancer surgery.
How is robotic prostate cancer surgery performed?
Most patients will meet their surgeon prior to the operation to discuss important aspects of the surgery as well as what to expect during recovery. The patient usually comes into hospital on the day of surgery and is sedated using general anaesthesia. Once the patient is anaesthetised, the surgeon begins the procedure by making a small incision (key-hole) to insufflate the abdomen (tummy) with an inert gas followed by the insertion of the telescope camera system. Following this, several other small incisions are made for insertion of robotic instruments and access for the surgical assistant.
The surgeon performs the procedure by operating the robotic instruments through a console, using hand controls and foot pedals. This procedure is performed using the Da Vinci robotic system, which allows for greater vision (3D) of the operating field as well as finer, more precise movements. Although the term robotic is used, there are no autonomous movements and the surgeon is under full control at all times.
The surgery includes removal of the prostate gland with the seminal vesicles (sacs that store sperm) and sometimes the pelvic lymph nodes if indicated. The urinary bladder is then sutured back onto the urethra (water pipe) and a temporary catheter is placed (rubber or silicone tube) which stays in for 7-14 days.
How is robotic prostate cancer surgery better than traditional methods?
Robotic surgery allows better vision in small spaces such as the pelvis where the prostate is located. The robotic instruments provide a wide range of articulated movement that can be very precise, this allows the surgeon to visualise and preserve important structures such as nerves and bloods vessels, enabling less blood loss and recovery of urinary and sexual function. Having smaller wounds compared to open surgical approaches allows quicker recovery and return to normal activities.
How long does robotic prostate surgery take?
The average operative time is two hours. In some patients, additional surgical procedures are required such as removal of the pelvic lymph nodes, which can make the surgery slightly longer.
Are there any risks/side effects?
All surgical procedures carry a degree of risk of side effects or complications. Robotic prostatectomy is generally regarded as a safe procedure and the likelihood of major complications is low. All patients will notice loss of semen on ejaculation and if sparing important nerve structures is not possible men will have a high chance of impotence (loss of erections).
The risk of long-term urine leakage after surgery is 3-5%. Most men will achieve cancer cure, however there is a risk of cancer being found outside the edges of the prostate (positive margin) which occurs in 2-10% of patients. Not all patients with positive margin will require additional treatment. One of the advantages of robotic surgery is reduced blood loss, as such the possibility of needing a blood transfusion is low (2-5%). More serious complications such as a need to convert to open surgery, injury to nearby structures, anaesthetic complications and nerve or eye problems occur less than 1% of the time.
What should you expect after robotic prostate cancer surgery?
Most patients will only spend one night in hospital. Because the wounds are small, the majority of patients will be able to walk quite soon after discharge with the help of simple painkillers. We advise patients to refrain from strenuous activity such as heavy lifting for at least 4 weeks.
If you think you may need your prostate assessed, or you are experiencing any other urological issue, you should consult a specialist like Mr Al Kadhi. You can request an appointment with him by visiting his Top Doctors profile.