Historically, prostate cancer has been the most common male solid organ malignancy and the second most common cause of cancer related death in men. With a 1 in 6 lifetime risk of developing prostate cancer, this malignancy continues to be a significant health issue for American men. Although we have been unable to eradicate prostate cancer, there have been a number of recent advances in the treatment of this disorder. One of the most promising recent surgical advances in the treatment of organ confined prostate cancer has been the daVinci robotic assisted laparoscopic prostatectomy (dVp).

For decades, the open radical prostatectomy has been the mainstay of curative intent therapy for organ confined prostate cancer. Unfortunately a number of theoretical risks/side effects such as impotence, incontinence and post operative pain have been a significant concern for patients undergoing this procedure. The dVp was popularized in 2000 as an attempt to improve upon the benefits of open radical prostatectomy such as favorable cancer control, as well as attempting to mitigate some of the side effects of the open prostatectomy such as blood loss, hospitalization time, post operative narcotic usage, incontinence and impotence. Although initial enthusiasm for the dVp was lacking, a number of recent articles as well as patient testimonials have demonstrated that the dVp offers equivalent to superior cancer control compared to the traditional open radical prostatectomy, while lessening blood loss, narcotic usage, hospitalization time, incontinence and impotence rates. Currently, dVp accounts for 70-80% of radical prostatectomies performed annually and has become the “gold standard” for radical prostatectomy. Unfortunately there is a significant learning curve associated with mastering the dVp, with these procedures almost uniformly being offered at large medical centers primarily related to the cost associated with purchasing the daVinci robot (1.65M USD) as well as the need for a dedicated robotic team in order to offer consistent and competitive results.

Technically, the daVinci robot offers a number of inherent advantages over traditional laparoscopy including a marked improvement upon mechanical advantage and maneuverability, elimination of any tremor, increased visualization secondary to image magnification, three dimensional visualization (traditional laparoscopy is two dimensional), decreased operating room time usage (depending on the procedure being performed), and a significantly shorter learning curve.

Appropriate patients for dVp are those who are candidates for open prostatectomy and primarily centers on patients with organ confined disease. Occasionally patients with a potential for extra-capsular extension yet clinically localized disease are candidates for radical prostatectomy. Whereas operating on the obese patient can often times be a technically challenging case when performed in an open fashion, in many instances these cases can be technically easier in the obese patient if the daVinci system is used. Patients that have had a number of prior abdominal surgeries or those patients whom are not good candidates for laparoscopy are generally not ideal candidates for the dVp. The dVp team typically includes a surgeon that operates the robot using a virtual screen and instruments (called the console), as well as a patient side surgical assistant, a surgical technician, a circulating nurse, and an anesthesiologist.

The procedure typically takes 2-3 hours (depending on the complexity) with a well-seasoned team. Typical hospitalization time is 1 day with patients routinely being admitted on the day of surgery. Upon discharge, the patient typically will wear a Foley catheter that is routinely removed one week after surgery. The procedure is usually performed through 5-6 laparoscopic ports.

Patient costs (out of pocket) are similar to those of traditional open surgery and patient risks are consistent with those of generalized laparoscopy. All patients should receive a pre-operative assessment by their physicians for any potential complicating factors, and are also given a discussion of other potential options for the management of their specific disease process. Whereas the historical comparison was the dVp to open surgical prostatectomy, we now truly have a minimally invasive therapy, which is more appropriately comparable to other minimally invasive prostate cancer therapies such as brachytherapy and cryotherapy. Ultimately this provides our patients and community with more attractive options for the management of prostate cancer thereby ultimately maintaining a greater quality of live and standard of living.

Coming Soon- Dieter's surgeries on video!

Visit Dr. Bruno at the Peninsula Urology Center

Related Articles

• - Dr Bruno Performs Robotic Prostatectomy (October 14, 2009)