Surgery
Surgery is the surgical removal of part or all of the prostate, and other nearby areas if necessary. This is done to treat:
- Prostate enlargement (benign prostatic hyperplasia, or BPH)
- Prostate cancer
Prostatectomy is the term for removing a portion of the prostate. Removing the entire prostate gland is called a radical prostatectomy. If the prostate was removed, semen can no longer be ejaculated. Whether or not a man can achieve an erection will depend on the degree to which nerves have been affected by the surgery. While men whose prostate has been removed can no longer produce semen, but they can still have a dry orgasm, which is a sexual climax without the release of semen from the penis. Men who wish to father children may wish to consider having their sperm frozen for use in the future.
Surgery is the most common option for men under 70 with the cancer confined to the prostate. Surgeons will try to remove the cancer, including local lymph glands if necessary, while trying to spare the surrounding nerves and muscles that affect urinary continence and sexual functioning.
Approximately 75 percent of men who undergo surgery never experience a recurrence of prostate cancer.
There are three approaches to radical prostatectomy:
- Suprapubic, where the surgeon operates through an incision below the navel to remove the prostate and, sometimes, the nearby lymph nodes
- Perineal, where the surgeon operates through an incision in the skin between the scrotum and the anus
- Laporascopic, where a thin tube-like instrument (laporascope) is inserted to remove the prostate through a small incision in the navel, with several more incisions made in the abdomen through which surgical instruments are passed.
Surgery always poses risks, and significant side effects can include:
- Incontinence (inability to control urination) is common following surgery, but most men recover within a few weeks or months. As many as 35 percent of men have permanent, mild but treatable stress incontinence, such as passing a little urine while coughing.
- Erectile dysfunction (ED) (inability to get an erection) is more common and more difficult to treat. The nerves located along the side of the prostate control erections. Sometimes they need to be removed to catch all of the cancer. Or, they may be damaged during surgery.
Nerve-sparing surgical techniques can improve the odds of recovering erections, from around 30 percent for men under 60 with one nerve spared, to about 76 percent for men under 60 with both nerves spared. Even if one nerve is sacrificed, one may be able to regain potency over time with the remaining nerve. Some patients regain potency over time with the use of ED drugs or medical devices.
Robotically Assisted Surgery
Robotically assisted surgery (such as the da Vinci Prostatectomy) is widely available where surgeons can a machine to control tiny surgical instruments with great precision. This procedure may increase accuracy, but as with all surgery, the level of experience of the surgeon is a critical factor to consider, as it takes time for surgeons to master new tools. The da Vinci system cannot act on its own; the surgery is performed entirely by the doctor.
This procedure requires only a 24-48 hour hospital stay and has a shorter recovery time. Although minimally invasive prostate removal aided by a robot can lead to less blood loss, shorter hospital stays and fewer complications, so far there is no evidence that the procedure improves cure rates.
The ultimate goal of the robotically assisted surgery field is to design a robot that can be used to perform closed-chest, beating-heart surgery. According to one manufacturer, robotic devices could be used in more than 3.5 million medical procedures per year in the United States alone.
Benefits of Robotically Assisted Surgery
After carefully considering all treatment options with your doctor and cancer care team, patients may decide robotically assisted surgery is the best option, as electing to undergo robotically assisted surgery may offer some of the following benefits:
- Less post-operative pain and discomfort
- Faster recovery and return-to-normal daily routine
- Reduced blood loss and need for transfusions
- Equivalent cancer control
- Earlier return to urinary continence
- Strong post-operative return to sexual functioning
- Less scarring
- Less risk of infection
How the da Vinci System Works
The anatomy around the prostate consists of muscles and delicate nerves that affect both urination and erections. During the removal of the cancerous prostate, the surgeon works to spare these very delicate muscles and nerves, utilizing the da Vinci instruments with a highly magnified 3D view of the anatomy. This system’s precision may assist the surgeon in preserving the anatomy necessary for urinary continence as well as the nerve bundles responsible for erections.
Once the prostate is cleanly detached, it is then removed through a small incision. The bladder is reattached to the urine channel over a catheter. This catheter is left in place for a short period of time to ensure proper healing. The surgery is completed with the removal of the instruments and the closure of the small incisions in the abdomen.
The da Vinci Surgical System is comprised of three components: a surgeon’s console, a patient-side robotic cart with four arms that are manipulated by the surgeon at the console and a high definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The surgeon’s hand movements are scaled and filtered to eliminate hand tremor and then translated into micro-movements of the proprietary "EndoWrist" Instruments. The da Vinci System is FDA-approved for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair and is used in more than 800 hospitals in the Americas and Europe.
Videos
da Vinci Prostatectomy procedure video (English)
da Vinci Prostatectomy procedure video (En espanol)
"Porter MacLean" Testimonial on Surgery Success
da Vinci S HD Overview for Patients
Find a Surgeon
Recent studies suggest the da Vinci Prostatectomy offers equivalent cancer control to open surgery and may reduce the risk of urinary incontinence and impotence following prostate cancer surgery.
Find a surgeon in your city who performs the da Vinci Prostatectomy (Robotic-Assisted Radical Prostatectomy).
History of Robotically Assisted Surgery
In 1985 a robot, the PUMA 560, was used to place a needle for a brain biopsy using CT guidance. In 1988, the PROBOT, developed at Imperial College London, was used to perform prostatic surgery. The ROBODOC from Integrated Surgical Systems was introduced in 1992, and is a robot to mill out precise fittings in the femur for hip replacement surgery. Further development of robotic systems was carried out by Intuitive Surgical with the introduction of the da Vinci® Surgical System and Computer Motion with the AESOP and the ZEUS robotically assisted surgical system. Intuitive Surgical purchased Computer Motion in 2003 and discontinued development of the ZEUS System.
The da Vinci Surgical System is comprised of three components: a surgeon’s console, a patient-side robotic cart with four arms that are manipulated by the surgeon at the console and a high definition 3D vision system. Articulating surgical instruments are mounted on the robotic arms which are introduced into the body through cannulas. The surgeon’s hand movements are scaled and filtered to eliminate hand tremor then translated into micro-movements of the proprietary "EndoWrist" Instruments. The da Vinci System is FDA cleared for a variety of surgical procedures including surgery for prostate cancer, hysterectomy and mitral valve repair and used in over 800 hospitals in the Americas and Europe. The da Vinci System was used in at over 48,000 procedures in 2006 and sells for about $1.2 million.
