Da Vinci Prostatectomy

Overview

Prostatectomy is a surgical procedure that removes all or part of the prostate gland. The prostate gland is located below the urinary bladder in the male pelvis. It encircles the urethra, which transports urine from the bladder to the penis.

The procedure is used to treat a variety of prostate-related diseases. It is most typically used to treat prostate cancer.

Depending on the condition, prostatectomy can be performed in a variety of ways. Minimally invasive surgery with robotic aid and traditional open surgery are also options.

The Da Vinci prostatectomy is the most modern prostate cancer therapy option. Robotic prostate surgery is highly indicated for individuals with localized prostate cancer. The Da Vinci prostatectomy is the outcome of cutting-edge medical technology and research.

Until recently, men with prostate cancer had few options for prostate surgery. Prostate surgery using the da Vinci robot is currently regarded one of the greatest therapeutic choices for prostate cancer as a result of recent technical advances.

Structure & Function of the Prostate

Prostate gland, chestnut-shaped reproductive organ in males placed directly under the urinary bladder, which adds fluids to sperm during ejaculation of sperm. The urethra, the canal that allows urine and sperm to travel through, is surrounded by the gland. The gland is rounded at the top and narrows to produce a blunt point at the bottom, or apex. The diameter at its widest point is around 4 cm (1.6 inches).

The two ejaculatory ducts, which transport sperm and fluid generated by seminal vesicles, converge and narrow near the center of the prostate before joining the urethra. The urethra then travels to the prostate's lower portion and exits near the apex.

The prostate gland is made up of tubular and sac-like glands that produce fluids into the urethra and ejaculatory ducts. A wet, folded mucous membrane lines the secretory ducts and glands. The folds allow the tissue to stretch while retaining fluid. Beneath this layer lies connective tissue, which is made up of a dense network of elastic fibers and blood vessels. Interstitial tissue is the tissue that surrounds the secretory ducts and glands and contains muscle, elastic fibers, and collagen fibers that provide support and firmness to the prostate gland. The prostate capsule is made up of interstitial tissue as well.

In men, the prostate provides 15-30% of the sperm released by the male. The fluid from the prostate is clear and somewhat acidic. It is made up of various protein-splitting enzymes; fibrolysin, an enzyme that lowers blood and tissue fibers; citric acid and acid phosphatase, which serve to raise acidity; and other ingredients such as sodium, zinc, calcium, and potassium ions and compounds.

The prostate normally develops between the ages of 10 and 14 throughout puberty. Around the age of 50, the prostate's size and volume of secretions typically decline. Prostate enlargement beyond midlife, which typically makes urination difficult, can be caused by inflammation or cancer.

Prostate cancer is the second most frequent cancer among males throughout the world. Males who do not emit enough of the male hormone androgen may benefit from androgen injections to maintain normal prostate function.

The Skene gland (paraurethral gland) in females, which is located at the lower end of the urethra, is considered homologous to the prostate gland in males and is sometimes referred to as the female prostate.

Types of Prostatectomy

The prostate gland is placed below the urine bladder in the lower abdomen. It protects the urethra, which connects the bladder to the penis.

Radical prostatectomy involves the removal of the whole prostate gland as well as the surrounding lymph nodes. This surgery is often suggested for individuals with locally advanced prostate cancer (one that has not spread to other organs). There are various methods for doing a radical prostatectomy.

These include:

Robot-assisted radical prostatectomy: It involves removing the prostate through tiny, lower-abdominal incisions. The surgeon directs a robot surgical equipment (such as the "da Vinci Surgical System") that conducts the surgery precisely.
Open radical prostatectomy: In which the prostate is typically removed via the lower abdomen by the surgeon (retropubic surgery). On rare cases, this treatment is performed through an incision between the scrotum and anus (perineal surgery).
Laparoscopic radical prostatectomy: In which the prostate is removed using a small camera and sophisticated surgical equipment.

The Da Vinci Prostatectomy for Prostate Cancer – Why So Popular?

Over the previous three decades, medical-surgical technology has advanced dramatically, having a significant influence on prostate cancer therapy and prostatectomy.

The da Vinci Surgical System, created by Intuitive Surgical, is the most well-known robotic prostatectomy accessible today.

Robotic prostatectomy is gaining favour as a less intrusive and less stressful prostate cancer therapy.

The da Vinci robotic prostatectomy allows surgeons to overcome many of the disadvantages of conventional open and laparoscopic prostatectomy.

The da Vinci robotic prostatectomy is a minimally invasive surgical method that employs precisely controlled robotic devices to execute the prostatectomy safely while improving patient recovery and prognosis.

Important Facts About the Da Vinci Prostatectomy

The da Vinci Surgical System is not a novel method, despite its rapid evolution in recent years. Intuitive Surgical first debuted it in 1999.
In the year 2000, the first da Vinci prostatectomy was performed in the world, in Frankfurt, Germany.
There are already over 1,700 da Vinci robots in use in hospitals across the world.
Over 775,000 patients worldwide have undergone a da Vinci surgery.
The da Vinci robot is used in three out of every four prostate cancer procedures in the United States.
When compared to radiation, robotic prostatectomy using the da Vinci machine has the lowest fatality rates.
All top-ranked hospitals in the US have at least one da Vinci robot.
There is no doubt we live in the era of robotic surgeries. It should not surprise us, considering all the great benefits of robotic prostate surgeries.

The Benefits of Da Vinci Robotic Prostatectomy

The majority of patients who have undergone the da Vinci robotic prostatectomy are discharged within 24 hours of their surgery.

The main benefits of the Da Vinci Robotic Prostatectomy are:

Quicker return to normal activity.
Shorter hospitalization (most patients go home the next day).
Less blood loss and fewer transfusions.
Reduced pain.

Furthermore, robotic prostatectomy is the only surgery that can secure the trifecta of prostate cancer survival:

Sexual function after prostate surgery.
Regaining continence after surgery.
After a prostatectomy, you should be cancer-free and have no PSA.

All of these advantages make the da Vinci robotic prostatectomy the first-line therapy for prostate cancer.

How Do You Prepare Before Surgery?

Before surgery, your doctor may order a visual scope examination of your urethra and bladder (cystoscopy). Cystoscopy allows your doctor to inspect your urinary system and assess the size of your prostate. Your doctor may also order further testing, such as blood tests or tests to precisely assess your prostate and urine flow.

Before your treatment, follow your doctor's recommendations. Here are some points to bring up with your doctor:

Food and medications
1. Your medications. Inform your doctor about any prescription, over-the-counter, or herbal drugs or supplements you use. This is especially critical if you use blood-thinning drugs, such as warfarin (Coumadin) or clopidogrel (Plavix), and non-prescription pain treatments, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others) (Aleve, others). Several days before the operation, your surgeon may advise you to stop taking drugs that raise your risk of bleeding.
2. Medication allergies or reactions. Talk to your care team about any allergies or reactions you have had to medications.
3. Fasting before surgery. Your doctor will most likely request that you refrain from eating or drinking anything after midnight. Take just the pills prescribed by your doctor with a little sip of water the morning of your surgery.
4. Bowel prep before surgery. You may be given a kit and instructions for giving yourself an enema to clear your bowels before surgery.
Clothing and personal items

Plan ahead to avoid wearing these items into surgery:

Jewellery.
Eyeglasses.
Contact lenses.
Dentures.
Arrangements after surgery.

Inquire with your doctor about how long you'll be in the hospital. You'll need to plan ahead of time for a ride home because you won't be allowed to drive after surgery.

Activity restrictions

You may not be able to work or do strenuous activities for several weeks after surgery. Ask your doctor how much recovery time you may need.

Components of the Da Vinci Robotic System for Prostate Removal

1. Computer 3-D Visualization

Even though robotic prostate surgery is performed remotely, doctors get the sensation that their hands are immersed in the patient's body. The da Vinci robot micro-scales all of the surgeon's hand motions. As a result, the surgeon feels intrinsically tied to surgery.

The image produced by robotic prostatectomy is substantially brighter and clearer than that produced by the human eye or any other 3-D laparoscopic prostatectomy endoscope. The robotic prostate surgery system has a patented camera that allows the surgeon to effortlessly zoom, rotate, or adjust the viewing of the picture.

As with previous laparoscopic systems, the resultant 3-D picture is bright and crisp, with no flicker. The da Vinci robotic prostatectomy is more advanced than other minimally invasive surgical methods currently available due to robotic hand simulation and 3-D imaging.

2. The da Vinci robot has a motion scaling feature

When performing robotic prostatectomy with the da Vinci System, the surgeon can employ "motion scaling," a technology that converts modest hand motions outside the patient's body into precise movements inside the body.

The surgeon uses natural hand and wrist movements to control the robotic prostate surgery robotic arms from the da Vinci console. Motion scaling during robotic prostatectomy is intended to provide higher accuracy than is typically possible in open and laparoscopic prostatectomy surgery. Traditional laparoscopic devices, in fact, provide surgeons less flexibility, dexterity, and range of motion.

Endo-Wrist proprietary devices and expanded range-of-motion capabilities of robotic arms allow surgeons to reach difficult regions and operate safely in the tight environment of the closed chest, abdomen, or pelvis.

Today's laparoscopic devices cannot execute precise motions and manipulations required for robotic prostate surgery, such as reaching behind tissues, suturing, and dissection. The device also eliminates the unpredictability of human hand motions and tremors.

3. The Patient-Side Cart of the da Vinci surgical system

The patient-side cart is positioned adjacent to the operating table during robotic prostatectomy, with the da Vinci robotic arms placed to give entry ports into the human body and prostate. Endo-Wrist tools and the da Vinci Insite Vision System are attached on the electromechanical arms of the robot, which resemble the surgeon's left and right hands.

They enable the ability to do complex tissue manipulation via entrance sites, or ports. Forceps, scissors, electrocautery, scalpels, and other surgical tools are among the Endo-Wrist devices. If the surgeon has to replace an Endo-Wrist instrument, which is typical during robotic prostatectomy, the instrument is removed from the surgical system using settings on the console. Typically, an operating room nurse standing near the patient manually removes and replaces the Endo-Wrist devices.

4. The Surgeon Console

The surgeon performs the robotic prostatectomy while sitting at the console, controlling the hand controls and monitoring the procedure live via the da Vinci Insite Vision System. This makes the surgeon more comfortable and lowers operating fatigue, which is a known obstacle in open surgery.

The robotic prostatectomy is concluded by removing the da Vinci devices and suturing the tiny incisions in the abdomen.

After the Da Vinci Prostatectomy

After surgery you should expect that:

You will be given IV pain relievers. After the IV is withdrawn, your doctor may prescribe pain relievers.
Your doctor will instruct you to walk on the day of or the day following surgery. You'll also do exercises in bed to get your feet moving.
You'll most likely be discharged the next day. The pelvic drain is removed when your doctor believes it is safe for you to go home. You may need to return to the doctor in a week or two to have the staples removed.
You'll be sent home with a catheter. Most men require a urinary catheter for seven to ten days following surgery. Urinary control might take up to a year to fully recover following surgery.
Make sure you understand the post-surgery procedures and any limitations, such as driving or moving heavy objects:
You'll need to progressively increase your exercise level. You should be able to resume your usual routine in four to six weeks.
You'll need to see your doctor several times to ensure that everything is well. Most men see their doctors after six weeks, then every three months for the first year, and twice in the second year. If you have any difficulties or concerns, you should consult your doctor as soon as possible.
You'll probably be able to resume sexual activity after recuperating from surgery. After simple prostatectomy, you can still have an orgasm during sex, but you'll ejaculate very little or no semen. After radical prostatectomy, full recovery of erectile function may take as long as 18 months for some men.

What are the Risks of Da Vinci Prostatectomy?

Erection problems are a potentially dangerous adverse effect of radical prostatectomy. The nerves that govern a man's capacity to get an erection are located next to the prostate. As a result, they are vulnerable to harm during a surgical procedure. It is feasible to retain these nerves and so sustain erectile function with some surgery.

Though it may take some time, around half of all patients discover that they regain some of their ability to get an erection. This can happen in three months in certain situations, but for most men, it takes six to twelve months.

Functional recovery will be influenced by:

The patient’s erectile function prior to surgery
How the nerves controlling erectile function were affected by the surgery
The age of the patient at the time of the procedure
Some medications, such as Viagra (sildenafil), Cialis (tadalafil), or Levitra (vardenafil) may help to alleviate the impotence that can occur after treatment, and contribute to a restoration of sexual function.

It is expected that up to 50% of men would have urine incontinence after a radical prostatectomy.

The urethra, the tube that transports pee from your bladder to your penis, runs through the center of the walnut-shaped prostate gland. The urethra is severed and subsequently rejoined to the bladder after prostate removal. Such a delicate procedure necessitates tremendous competence, and the surgeon's experience can help reduce the chance of incontinence issues.

Urinary incontinence that lasts more than 12 months following a prostatectomy may necessitate therapy.

Are There Alternatives to Da Vinci Prostatectomy?

Any alternative treatments are likely to depend on medical opinion about the stage of your cancer and any chance that it may return. Some alternative options may include:

Active surveillance (watch and wait).
Radiation therapy.
Hormone therapy.
Chemotherapy.
Cryotherapy (freezing).

Da Vinci Prostatectomy Cost

There are almost 1,700 da Vinci robots in the globe, and their price is not insignificant.

The system is utilized in a number of medical operations, including urological therapies.

According to a study published in the Jama Network, even if robotic-assisted radical prostatectomy is initially related with a greater cost (2367$), the expenditures are totally attenuated after a year. This is due to fewer medical appointments, problems, and functional side effects.

Conclusion

Robotic prostatectomy, also known as robotic-assisted laparoscopic radical prostatectomy, is a surgical procedure that removes the prostate, seminal vesicles, and vas deferens to treat prostate cancer. In contrast to the typical "open" surgery, the daVinci Surgical System is used to complete the procedure through tiny incisions.

The daVinci Surgical Device, a sophisticated system that simplifies surgical procedures through tiny incisions and laparoscopic ports, is used for robotic surgery. The tools are controlled by the surgeon through a console, and motions are filtered and scaled to improve precision, control, and range of motion. The unique camera allows the surgeon to see the surgery in 3-D, while the telescope magnifies vision up to 12x for enhanced visual detail.