In prostate cancer surgery, millimeters matter.
By John A. Watson, M.D. Princeton HealthCare System
Located just beneath the bladder, the prostate is attached to numerous nerve fibers and blood vessels that play an important role in urinary continence and sexual function. To spare these nerves and vessels during surgery, they must be delicately and precisely separated from the prostate before its removal.
Precision, vision and control are essential.
That is why specially trained urologists at University Medical Center at Princeton are using the Da Vinci Surgical System to perform prostatectomy — the surgical removal of the prostate.
The Da Vinci System provides surgeons with enhanced capabilities, including a magnified, 3D view of the operating field and greater dexterity and range of motion.
Prostate cancer is the most common type of cancer found in American men other than skin cancer, and according to the American Cancer Society, nearly 218,000 men will be diagnosed with the disease this year.
Fortunately, when detected and treated early, the majority of men will make a full recovery. In fact, there are more than 2 million prostate cancer survivors alive in the United States today.
Early prostate cancer rarely causes symptoms and is typically first found by a screening test to measure the level of prostate-specific antigen (PSA) in the blood, as well as a digital rectal exam. When symptoms do occur, they can include:
• Frequent urination, especially at night.
• Inability to urinate.
• Weak or interrupted flow.
• Painful or burning urination.
• Blood in the urine or semen.
• Frequent pain in the lower back, hips or thighs.
If abnormalities are detected, a physician will order a biopsy of the prostate to confirm the presence of cancer.
The risk for developing prostate cancer increases with age. According to the National Cancer Institute, prostate cancer is most often diagnosed in men 65 and older, and by age 80, more than half of American men have some cancer in their prostate.
Given that prostate cancer is a slow growing cancer, treatment depends in large part on health and life expectancy. Some men may initially opt to monitor the progression of the disease before moving forward with active treatment. Others may choose radiation therapy to attack the cancer cells.
However, in most cases, surgery to remove the prostate remains the standard treatment approach for localized, early stage prostate cancer.
Surgical Approaches to Prostate Cancer.
Traditional surgery requires an 8- to 10-inch incision across the pelvic area to access the prostate and often results in blood loss that requires transfusion, along with significant post-surgical pain, a lengthy recovery and an unpredictable, potentially long- term impact on continence and sexual function.
Conventional laparoscopic surgery, on the other hand, is performed using a specialized surgical camera and rigid medical instruments to access and remove the prostate through a series of small incisions. While conventional laparoscopy can be effective for routine procedures, it is rarely used for prostatectomy because of its technical limitations.
Now, an increasing number of surgeons — including those at University Medical Center at Princeton — are using the Da Vinci Surgical System to perform minimally invasive prostatectomy.
Prostatectomy with Da Vinci.
With the Da Vinci Surgical System, small incisions are used to introduce miniaturized wristed instruments and a high-definition 3D camera. Seated comfortably at a console, the surgeon views a magnified, high-resolution 3D image of the surgical site.
At the same time, state- of-the-art robotic and computer technologies scale, filter and seamlessly translate the surgeon’s hand movements into precise micro-movements of the medical instruments.
Often called a robot, the system cannot be programmed, nor can it make decisions on its own. Rather, the Da Vinci System requires that every surgical maneuver be performed with direct input from your surgeon.
For many patients, prostatectomy with Da Vinci offers numerous potential benefits, including shorter hospital stay; less pain; less risk of infection; less blood loss, minimizing the need for transfusions; less scarring; faster recovery, and quicker return to normal activities.
Moreover, studies show that surgery with Da Vinci offers additional benefits for prostate cancer patients when compared to other treatments, including:
• Effective cancer control. Experienced surgeons achieve excellent results in removing prostate cancer without leaving cancer cells behind.
• Improved and early return of continence. More than 90 percent of patients have normal urinary function within three months after surgery with Da Vinci.
• Quicker and improved return of sexual function. Eighty-six percent of men return to normal sexual function within 12 months after surgery with Da Vinci.
While an effective approach to treating prostate cancer, Da Vinci prostatectomy is not for everyone. It is important to talk to your doctor about your expectations for recovery of continence and sexual functions and explore all available treatment options to determine whether Da Vinci surgery is the best treatment for you.
For more information about the Da Vinci Surgical System at University Medical Center at Princeton or to find a University Medical Center at Princeton Da Vinci surgeon, call 888-742-7496.
John Watson, M.D., specializes in urology and urologic surgery. He is a member of the medical staff and a Da Vinci surgeon at University Medical Center at Princeton.