Prostatectomy - Removing the Cancerous Prostate
Removal of the cancerous prostate gland and certain surrounding structures is known as a radical prostatectomy. In the United States, 91% of prostate cancer diagnoses are estimated to be clinically localized (confined to the prostate with no regional lymph node or distant metastasis, also referred to as stages T1 or T2) when first detected 1 . Because the entire prostate gland is removed with a radical prostatectomy, the major potential benefit of this procedure is a cancer cure in patients for whom the prostate cancer is truly localized. 2
Patients should discuss radical prostatectomy with their doctor to determine if they are an appropriate candidate. The two potential side effects that most concern patients considering a radical prostatectomy are incontinence and an inability to achieve erections.
Today, most patients are candidates for nerve-sparing radical prostatectomies when their cancer is detected early, and preventing nerve damage may significantly minimize the potential side effects of incontinence and impotence.
The vast majority of patients that undergo a radical prostatectomy see a return of urinary continence and sexual function after a recovery period post-surgery, though there is no guarantee that these benefits will apply for every patient. The length of this recovery period depends on a variety of factors and patients should openly discuss what recovery they should individually expect with their doctor.
Types of Prostatectomy
Approaches to this procedure include traditional open surgery, conventional laparoscopic surgery or da Vinci Prostatectomy, which is a robotic-assisted laparoscopic surgery.
Traditional Open Prostatectomy
With a traditional open procedure, your surgeon uses an 8-10 inch incision to access the prostate. This approach often results in substantial blood loss and a long, uncomfortable recovery.
Conventional laparoscopy uses a surgical camera and instruments to access and remove the prostate using a series of small incisions. It relies on standard 2D video and rigid instruments, technical limitations that can be challenging for the surgeon. Because of these drawbacks, conventional laparoscopy doesn't lend itself well to complex procedures like prostatectomy. Therefore, very few urologists use this approach for prostatectomy.
da Vinci Prostatectomy
da Vinci Prostatectomy is a robotic-assisted radical prostatectomy performed in a minimally invasive approach. Surgeons have demonstrated (and widely published) results with da Vinci Prostatectomy that offer excellent rates of cancer control while speeding the return of urinary continence and sexual function.
- AUA 2007 Guidelines page 4 (Of the 234,460 men in the United States diagnosed with prostate cancer annually, 91% have localized disease.)
- 2. AUA 2007 guidelines page 14
All surgery presents risk, including da Vinci Surgery. Results, including cosmetic results, may vary. Serious complications may occur in any surgery, up to and including death. Examples of serious and life-threatening complications, which may require hospitalization, include injury to tissues or organs; bleeding; infection, and internal scarring that can cause long-lasting dysfunction or pain. Temporary pain or nerve injury has been linked to the inverted position often used during abdominal and pelvic surgery. Patients should understand that risks of surgery include potential for human error and potential for equipment failure. Risk specific to minimally invasive surgery may include: a longer operative time; the need to convert the procedure to an open approach; or the need for additional or larger incision sites. Converting the procedure to open could mean a longer operative time, long time under anesthesia, and could lead to increased complications. Research suggests that there may be an increased risk of incision-site hernia with single-incision surgery. Patients who bleed easily, have abnormal blood clotting, are pregnant or morbidly obese are typically not candidates for minimally invasive surgery, including da Vinci Surgery. Other surgical approaches are available. Patients should review the risks associated with all surgical approaches. They should talk to their doctors about their surgical experience and to decide if da Vinci is right for them. For more complete information on surgical risks, safety and indications for use, please refer to http://www.davincisurgery.com/da-vinci-surgery/safety-information.php.
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