Robotic Prostate Surgery
The robotic surgical platform can be applied to allow radical surgical excision of the prostate and surrounding fascia and the pelvic lymph nodes. The traditional approach was to perform an open lower midline extra peritoneal operation, which in the end achieves the same outcome.
The difference is in post operative analgesic requirements and return to normal activities and convalescence. There are differences as well, that relate to intra-operative dissection abilities and blood loss volumes and operating times. The robotic platform allows for 3-dimensional viewing within the pelvis and significant magnification during dissection.
The robotic patients tend to convalesce over a shorter period and generally I find there is less physiologic stress on the body in the recovery phase.
Both groups still require a catheter to allow the join between the bladder and urethra to heal, that is removed at 7-10 days. The robotic approach allows the operation to be performed through several key hole incisions, and therefore there is less pain.
The 3-dimensional viewing and magnification allows for careful inspection and dissection and sparing of the neurovascular bundles.
Nerve sparing of varying degrees is only applicable, depending on the extent of the cancer and nerve sparing is best applied when there is clear biopsy and MRI evidence that the cancer is organ confined. In non-organ confined cT3 cancers, nerve sparing may not be appropriate.
The robotic approach can also be applied to locally advanced cancers and even to cancers where there may be low level lymph node involvement, to allow for surgical clearance of the pelvis, however these patients typically also need adjuvant radiotherapy and/or hormonal manipulation and referral to a medical oncologist.