Robotic Prostatectomy

What's New in Prostate Cancer Surgery?

Robotic Radical Prostatectomy offers a chance to control prostate cancer while minimizing the side effects of surgery. The DaVinci Robot is a surgical tool which provides the surgeon with the ability to operate within the body through small incisions in the abdomen.

Robotic Prostatectomy Achieves the Same Goals as Traditional Open Surgery

The prostate and tumor can be removed in its entirety.
Nerves and arteries to the penis which run closely adherent to the prostate can be preserved, or sacrificed, depending on the goals of the surgery.
The robot can help visualize and preserve structures necessary to prevent the leakage of urine.

Greater Dexterity

Small, dexterous instruments, with can assist with dissection, the gentle handling of tissues, and the repair of the bladder neck:
Computer assisted tremor reduction steadies instruments
Movements can be scaled down until they are incredibly precise
“Wristed” instruments allow movements which mirror the motions of the human hand.
The bladder neck and urethra can be connected with a watertight running stitch instead of the traditional interrupted sutures, which are tied down blindly using the open technique.

Better Visualization

View Into Surgical Console

There is better visualization of the entire operation due to markedly decreased blood loss, and the properties of the robotic scope:
The instrument has the ability to “fly down” to within millimeters of important structures,
The Robot has the ability to see around corners with angled scopes, and to magnify structures.
The operating field is illuminated by powerful fiberoptic lights, which are not blocked by the surgeon’s hands or the assistant’s head.
The Robot provides a three dimensional view which allows depth perception.

The Binocular Lens of the Robotic Scope Provides Depth Perception

Precision Control Achieved Through Advanced Technology

The surgeon sits comfortably at the console, close to the patient

The robotic instruments are tended by an assistant surgeon at the bedside

Robotic Surgery Enhances Surgical Technique

Using traditional open technique, a lower abdominal incision forces the surgical team to look at angle under overhanging pubic bone. The surgeons must constantly adjust the position of lights, their hands and their surgical instruments to enable them to both operate and to see what they are doing. Often, a surgeon’s head blocks the light; sometimes headlights are worn. Many surgeons wear glasses fitted with magnifying lenses. Typically, only the primary surgeon has an unobstructed view. There is more bleeding during the open technique because the pressurized abdomen used in the robotic technique stops the low pressure oozing from veins in the pelvis. The surgeons must constantly remove the blood from the pelvis in order to see what they are doing. A well trained surgical team can overcome these obstacles, but they are consistently present.

Robotic Surgery In Perspective

Are there difficulties inherent in Laparoscopic or Robotic Surgery which are different from those in open technique? Yes. Laparoscopic skill is specialized skill that is developed in addition to good open technique. These skills are best achieved through mentorship with a skilled surgeon, just as all surgical skills are. This is the purpose of surgical training programs. There are currently many open surgeons who have years of experience and are reluctant to spend time training to use laparoscopic technique or to use the robot. There are also training programs which are struggling to teach their surgeons proper open technique due to a decrease in the volume open cases. It is important to find a surgeon who is comfortable and experienced with both Open and Robotic techniques. Dr. Nobert was trained at a busy institution where open surgical volume for prostate cancer surgery was higher than 95% of training programs. This was at a time when Robotic Surgery was just coming in to being, and Dr. Nobert helped develop it at the institution where he trained. Later, he brought it to St. Lukes-Roosevelt Hopsital, where it has now been performed it for many years. The DaVinci Robot is an elegant instrument for performing cancer surgery which is faithful to the surgical principles of the greatest open surgeons.