ROBOTIC PROSTATE SURGERY

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ROBOTIC PROSTATE SURGERY

ROBOTIC PROSTATE SURGERY

The surgical approach to prostate cancer is currently recommended by the guidelines of the major Society of Urology (EAU and AUA) as decisive in case of prostate cancer in the early stages. The surgeon's objectives in the treatment of prostate cancer are mainly two: on the one hand to eradicate the disease. On the other it has the aim of safeguarding, preserving nerves, the ability to retain urine (continence) and to have sex.

Robotic prostate surgery, or robotic prostatectomy, or Robot-Assisted laparoscopic radical prostatectomy (RARP or RALP), has become in recent years a possible option for patients who have to undergo surgery for prostate cancer.

With robotic arms, positioned through 5-6 small holes on the abdominal wall, the surgeon can intervene by removing the prostate and, when possible, preserving the vascular-nervous bundles, vital to the maintenance of continence and erection.

Scientific literature has now demonstrated that, in terms of healing, the results of open prostatectomy and robotic prostate surgery (RALP) are stackable. However, robotic surgery offers significant advantages since it preserves the functions of the prostate, shortens the time of hospitalization and convalescence, limits blood loss and the size of the surgical wound.

The new robotic technique allows performing the same actions of the surgeon's hand directly or through laparoscopic instruments. The view is, however, enlarged, close and three-dimensional, and the surgeon has 7 degrees of freedom of movement, that allow him to operate even in very confined spaces.

This ensures greater accuracy in identifying the structures and permits to intervene on dissection planes that with other techniques are less visible. The surgeon can be very precise in the demolishing phase of the intervention, in order to preserve nerves and vessels, thereby reducing the intraoperative blood loss.

 

RADICAL ROBOTIC PROSTATECTOMY

Definition: the Robot-Assisted Radical Prostatectomy involves the removal of the prostate and possibly lymph nodes without a real surgical wound. It is performed with the help of a camera and the introduction of Da Vinci robot arms through small skin incisions. This technique is recommended for the treatment of Prostate Cancer.

Description of the technique: First, with a special needle, carbon dioxide is introduced into the abdomen of the patient to allow the surgeon a good view; then, through a 1-2 cm incision below the navel, the surgeon inserts into the patient’s abdominal cavity an introducer tube, inside which is placed an optical instrument, equipped with a mini camera. Through other small incisions, he inserts additional tubes for the introduction of the arms of the robot, in addition to one or two accesses for a second operator, who helps him with laparoscopic instruments.

The surgeon performs the surgery at the console of the robot; the sophisticated camera allows a three-dimensional view of the operating field. He isolates the gland, binds the dorsal venous complex (Santorini Plexus), isolates and ties the tubes. Then he removes the prostate and seminal vesicles; these will go to a collection bag, which is then extracted from the incisions on the abdomen.

At this point the surgeon connects the bladder neck and urethra through the stump (this procedure is called “anastomosis”). Then he places a bladder catheter and an external drainage to remove any remaining blood or lymph.

The surgery lasts 2 to 4 hours and is performed under general anesthesia.

Post-surgery recovery: The day after surgery, according to the assessment of the amount of collected secretions, the drainage is generally removed. Two or three days after surgery the patient is discharged with a bladder catheter, which will be removed in the clinic one week after surgery.

Results: in terms of healing, the results of laparoscopic and traditional surgery are stackable. However, robotic surgery offers significant advantages: less post-operative pain (because there is no surgical wound), faster recovery, shorter hospitalization, higher and faster recovery of continence and sexual potency.

Side effects: The side effects of this type of intervention are mainly related to continence and sexual potency: it is true that the patients operated with the Da Vinci robot recover faster and more often continence and sexual potency of those who are operated with traditional technique. The anatomical structures related to these functions, however, are sometimes compromised by the disease, and even surgery can not preserve them.

After surgery care at home: After the operation, it is appropriate to drink a lot of water and to avoid physical efforts for several weeks. It is usually not necessary to follow a special diet. In case of abdominal or lower limb wall changes, pain, fever (above 38.5 °), bleeding, dizziness, nausea, also many days after surgery; the patient should contact the doctor or the urologist.