Prostate cancer is a malignant cancer that can spread to the lymph nodes, bones and other parts of the body. It is the most common cause of death in elderly men over 75 years of age.
The treatment of prostate cancer depends on the stage of the cancer and the overall health status of the patient and may include surgery, radiation therapy, chemotherapy, and hormone therapy. Surgery is the gold standard for the treatment of prostate cancer. It involves the complete removal of the cancerous prostate gland and also helps confirm the diagnosis, by biopsy, and ascertain the need for any additional therapy.
Surgery for prostate cancer can be done either through open approach (a large incision over the abdomen) or through laparoscopy (few small holes over the abdomen). However, a common problem faced by the patient after surgery, with either of the approaches, is a loss of bladder control and erectile dysfunction.
Open radical prostatectomy is a surgery performed to remove the prostate gland in order to treat prostate cancer. The procedure is used for cancers contained within the prostate (localized cancer). It is performed under spinal or general anaesthesia. Your surgeon can approach the prostate by making an incision from your navel to your pubic region or from the scrotum to the anus. The prostate gland and surrounding abnormal tissue is removed.
During dissection, your doctor may try to prevent erectile difficulties by sparing the nerves (that control erection) attached to the prostate gland. This type of surgery is termed as nerve-sparing open prostatectomy, and is suitable for early stage prostate cancer which is completely confined within the prostate gland.
In cases where the cancer is tangled along with these nerves, your surgeon may not be able to spare the nerves and the nerves will be excised along with the prostate gland. This type of surgery is termed as non-nerve sparing prostatectomy and can cause erectile dysfunction after the surgery.
Open radical prostatectomy may take 2 to 4 hours to complete and you will stay in the hospital for about 4 days after the surgery. Like all surgeries, open radical prostatectomy may be associated with certain complications which include erection problems, tightening of the urinary opening, difficulty controlling urine and bowel movements, and injury to the rectum.
There are alternate minimally invasive/laparoscopic procedures that can be availed of. The open radical prostatectomy is restricted to selected cases only. Your surgeon will discuss your options with you based on your particular medical history.
Robotic radical prostatectomy is a new advanced laparoscopic approach that overcomes the limitations of the traditional open as well as the laparoscopic approach. It enables the surgeon to perform complex surgery through tiny incisions, with precision and ease, improving the outcome and reducing complications.
Robotic radical prostatectomy involves two machines, a control unit or the surgeon’s console and a patient unit. The surgeon sits at the control unit, away from the operating table, and controls the movement of the four robotic arms of the patient unit, present near the operating table. One of the robotic arms holds and positions a 3D high definition camera through the incision in the operated area providing images of the operation site to the surgeon at the control unit. These images are high resolution 3D images, superior to the 2D images in the laparoscopic approach. Moreover, the images can also be magnified by 10 to 12 times. The other three robotic arms are used to hold small miniature instruments, which are used for the surgery. These instruments are introduced through the tiny (1-2cm) incisions over the patient’s abdomen. These miniature instruments are more flexible compared to the long handled rigid instruments of the traditional laparoscopic surgery. A wide range of these instruments are available to the surgeon to perform various specialized surgical tasks.
The robotic arm cannot be programmed to do the surgery on its own. Instead, it translates the surgeon’s hand movements, at the control unit, into precise movements of the micro-instruments in the operation site, minimizing tremors that may occur from unintended shaking of the surgeon’s hands. The enhanced vision and superior control of the micro-instruments helps in precise removal of the prostate without damaging the nerve fibres and the blood vessels near it, which are critical for the maintenance of bladder control and erectile function. Nerve sparing, however, is not possible in patients with an advanced cancer that has spread beyond the prostate. Precise removal of the cancerous tissue with a border of healthy tissue reduces the chances of recurrence of the prostate cancer. This technique provides a novel treatment approach for the management of prostate cancer with a quicker recovery and control of sexual and urinary function, in most patients. It also provides additional benefits of less blood loss, less pain, shorter hospital stay, faster return to normal routine activities and a lower incidence of complications.
Talk to your doctor for any unanswered queries on robotic radical prostatectomy and what to expect from the surgery in individual cases.
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