Precision Prostate Cancer Surgery
Prostate cancer is the leading cause of cancer in men. One out of every six men in the United States is expected to develop prostate cancer at some time during his life. The prostate gland, located just below the bladder and in front of the rectum, is about the size of a walnut and surrounds the urethra (the tube that empties urine from the bladder.) The prostate gland produces fluid that makes up part of the semen.
Prostate Cancer is a disease in which cancer cells form in the tissues of the prostate. Learn more about prostate cancer....
When Millimeters Matter
In prostate cancer treatment, millimeters matter. Nerve fibers and blood vessels are attached to the prostate gland. Damage to these nerves can contribute to erectile dysfunction, one of the more feared side-effects of prostate cancer surgery. To spare these nerves, they must be delicately and precisely separated from the prostate before its removal. Surgeons use the precision, vision and control provided by da Vinci to assist them in removal of the cancerous prostate while preserving important nerves and blood vessels.
In several large published studies, da Vinci prostatectomy has shown equal or better rates of optimum cancer removal when compared to other forms of surgery. Other concerns for prostate cancer patients are urinary incontinence and sexual dysfunction after treatment. Studies show patients who undergo a da Vinci prostatectomy may experience a faster return of urinary continence following surgery and a lower rate of urinary pain than patients who opt for radiation (brachytherapy) therapy. Several studies also show that patients who are potent prior to surgery have experienced a high level of recovery of sexual function (defined as an erection for intercourse) within a year following da Vinci Surgery. Talk to your surgeon about reasonable expectations for recovery of sexual function and a rehabilitation program that may include exercises and drug therapy. Learn more about prostate surgery with da Vinci
What to Expect
Shortly before the operation, anesthesia is administered and the patient goes to sleep for the duration of the operation, which typically lasts two to four hours. The procedure begins when the patient’s abdomen is inflated with carbon dioxide gas, creating an operating space for the surgeon. Next, six small incisions, 1/4 to 1/2 inch in length, are made in the patient’s abdomen and ports are inserted to keep the incisions open.
During the procedure, the surgeon uses the da Vinci System’s laparoscopic surgical instruments and video camera, via the temporary ports, to direct the dissection of the prostate gland and adjacent tissue. If deemed appropriate, the surgeon tries to preserve the nerves attached to the patient’s prostate gland. One major benefit of the robotic system is that the high-definition optics allow the surgeon to see the tiny nerves, making it possible to navigate around them. By comparison, surgeons using more conventional approaches generally rely on their knowledge of the anatomy to spare the nerves. But that can be risky if the patient's anatomy is not exactly as it appears in the textbooks. At the end of the surgery, the ports are removed from the patient’s abdomen and the remaining incisions are closed with sutures.
After surgery, the patient wakes up very groggy and with a urinary catheter in place. He will likely spend one night in the hospital resting and recovering from the effects of the anesthesia. As the anesthesia wears off, there may be some discomfort, for which pain medication may be prescribed. Because a catheter typically remains in place for approximately 7 days, the doctor will review guidelines for use that will ease discomfort and ensure proper function of the catheter during this time. The first week after surgery will likely be spent resting; however, frequent walks are encouraged. Depending on the individual, regular activities may resume as soon as soon as a few days after surgery; although straining and heavy lifting is discouraged for the first four weeks. About a week after surgery, a post-operative follow-up is scheduled, at which time bladder function may be assessed. This is done by filling the bladder with saline via the catheter, removing the catheter and then allowing the patient to void naturally. Some incontinence after surgery is normal and is typically managed with medication until bladder control resumes. Erectile dysfunction may also be a side effect of surgery. Like incontinence, this side effect may be discussed with the doctor and managed with medication until it lessens or completely resolves over time.
Benefits of da Vinci Prostatectomy
- Less pain
- Less risk of infection
- Less blood loss and fewer transfusions
- Less scarring
- Lower incidence of impotence and urinary incontinence
- Shorter hospital stay
- Quicker return to normal activities
For comprehensive treatment of prostate cancer Saint Francis surgeons work closely with the Saint Francis/Mount Sinai Regional Cancer Center.