Robotic Prostate Surgery

Radical prostatectomy, or surgical removal of the prostate and surrounding cancerous tissues, is considered to be one of the most effective ways to eradicate prostate cancer. Radical prostatectomy is a complex and delicate procedure due to many factors, including the location of the prostate gland deep inside the pelvis.

In radical prostatectomy, surgeons remove the entire prostate gland, along with both seminal vesicles, both ampullae (the enlarged lower sections of the vas deferens), as well as additional surrounding tissues. The section of urethra that runs through the prostate is cut away, and some of the sphincter muscle that controls the flow of urine may also be removed with it.

The emergence of radical prostatectomy as a preferred prostate cancer treatment has corresponded with wider availability of minimally invasive surgery. A minimally invasive approach to prostate surgery can typically reduce complications and promote faster recovery times than open surgery. In the United States today, surgeons use one of three approaches to radical prostatectomy: open surgery, laparoscopic surgery and robotic-assisted laparoscopic surgery. The latter two are minimally invasive procedures.

da Vinci Images ©2012 Intuitive Surgical, Inc.

Open Prostatectomy

An open prostatectomy requires an eight- to 10-inch incision on the patient's abdomen. In contrast, conventional laparoscopic and robotic-assisted laparoscopic approaches require several dime-sized incisions, or operating "ports," which are used to introduce narrow-shafted instruments. Surgeons and assistants maneuver the instruments from outside the body, under vision provided by a surgical camera.

The potential advantages of laparoscopic and robotic-assisted laparoscopic prostatectomy over conventional open surgery include smaller incisions for less post-operative pain and improved cosmetics; reduced blood loss and less need for blood transfusions, as well as a faster return to normal activities.

The two major drawbacks of conventional laparoscopy are that it relies on the use of rigid, hand-held instruments and visualization provided by a standard 2D video monitor. While these technologies enable smaller incisions, they can limit the surgeon's sense of depth of field, his/her dexterity and precision. Standing at the patient's side, the surgeon must operate in a counterintuitive fashion, moving the long-shafted instrument handle in precisely the opposite direction as he or she intends to move the instrument tip. Surgeons maneuver the instruments while looking up at the 2D view of the operating field projected on a tableside video monitor and while instructing an assistant on how to position the surgical camera.

The da Vinci Surgical System uses advanced robotic technology to provide natural depth of field and allow a surgeon's hand movements to be scaled, filtered and translated into precise micro-movements of tiny instruments at the operative site. The superior visualization, enhanced dexterity, precision and control enable the surgeon to perform complex procedures — like radical prostatectomy — through dime-sized operating "ports."

For most patients, da Vinci Prostatectomy (dVP) offers substantially less pain and a much shorter recovery than traditional prostate surgery. Other advantages may include reduced need for blood transfusions, less scarring and less risk of infection. In addition, recent studies suggest that dVP may offer improved cancer control and a lower incidence of impotence and urinary incontinence.

Because of the benefits it offers, dVP has become the fastest growing treatment for prostate cancer in the United States, and has already been used to successfully treat thousands of prostate cancer patients worldwide.