Robot-assisted da Vinci prostatectomy for prostate cancer

If a prostate carcinoma (prostate cancer) has not spread past the prostate, the best treatment option is surgical removal of the prostate and seminal vesicles. Whereas in the past this procedure required an open operation, today a robot-assisted da Vinci prostatectomy is available, during which the prostate is removed using three-dimensional vision in a keyhole technique. The advantages of the robot-assisted surgical technique include less blood loss and faster recovery.

Questions about the diagnosis and treatment of prostate cancer

If the prostate carcinoma is limited to the prostate gland and the tumour has not spread yet, full recovery is possible. The tumour must be discovered early, which can be difficult as it usually does not cause any symptoms. As a part of preventative care, palpation of the prostate and transurethral ultrasound from the rectum are just as useful as determining the PSA value to assess the risk of prostate carcinoma.

Prostate cancer is located in the prostate or prostate gland and has a tendency to spread to the seminal vesicles and the lymph nodes in the pelvis. For this reason, in a radical prostatectomy, the prostate gland with attached seminal vesicles and part of the lymph nodes in the pelvis are removed.

Surgical access can be done via two different approaches, namely open surgery or the minimally invasive endoscopic approach. In open surgery, the prostate is removed via an incision in the abdomen or by means of an episiotomy. The removal of lymph nodes via the perineal incision is only possible to a very limited extent. In endoscopic access (“keyhole surgery”), a distinction is made between conventional laparoscopy (laparoscopy of the abdomen) and the robot-assisted procedure. The Goldstadt Private Clinic uses the robot-assisted da Vinci procedure.

Prostate carcinoma metastasis mainly to the lymph nodes in the pelvis or in the back of the abdomen (retroperitoneum). Other typical metastatic sites include the bones, lungs, and the liver.

Short info on robot-assisted da Vinci prostatectomy

Indication Localised prostate carcinoma
Procedure Surgical procedure using the keyhole technique. The surgeon operates the minimally invasive instruments.
Surgery time Approx. 3-4 hours
Clinic stay 1 week
Note Lower blood loss and faster recovery than incision surgery

Questions about robot-assisted da Vinci prostatectomy

Inpatient admission for a robot-assisted da Vinci prostatectomy takes place the day before the procedure. The operation takes place under general anaesthesia. The minimally invasive instruments of the robot are inserted into the abdominal cavity using the keyhole technique. Using three-dimensional vision, the surgeon carefully dissects the prostate and then removes it completely with the attached seminal vesicles. Robot-assisted surgery allows for particularly precise visualisation and protection of the sphincter muscles. The associated lymph nodes are also removed, then the bladder is sutured to the urethra above the sphincter and secured with a bladder catheter. Postoperative care is provided in the recovery room before the patient is transferred to a normal ward. The bladder catheter is removed after checking the tightness of the anastomosis (connection of the bladder to the urethra). Once the catheter is removed, the patient is able to empty the bladder again by himself. If bladder emptying is satisfactory, the patient is discharged. The entire inpatient stay lasts about one week.

Due to the tenfold magnification, the anatomical structures (nerves, vessels, sphincter muscle, etc.) can be visualised much better and spared, making it easier to maintain continence and potency. Compared to the conventional (incision) surgical technique, the result is a better outcome, less blood loss, less pain, and a shorter hospital stay.

No.

In principle, a robot-assisted da Vinci can be performed on any patient. In certain individual cases, pronounced adhesions in the abdominal cavity may be a reason to not perform the procedure.

The use of the da Vinci robot allows for particularly precise preparation of the tissue layers. This is an important prerequisite for preserving erectile function. Depending on the size, location, and degree of malignancy of the prostate carcinoma, the nerve plexus necessary for erection can be preserved. The success of erection-preserving surgery depends on whether only one or both sides of the erectile nerves can be spared.