Prostate cancer:
Robot-assisted surgery with the da Vinci robot and radiotherapy

If the prostate cancer is confined to the prostate and the tumour has not yet spread, the disease can be cured. A prerequisite is therefore early detection of the disease, which usually causes no symptoms. As part of screening, palpation of the prostate and transrectal ultrasound from the rectum, as well as the PSA value, help to assess the risk of prostate cancer well.

Prostate cancer is located in the prostate gland and tends to spread to the seminal vesicles and the lymph nodes in the pelvis. For this reason, radical prostatectomy involves removing the prostate with the attached seminal vesicles as well as some of the lymph nodes in the pelvis.

Surgical access can basically be achieved via two different approaches: open surgery or minimally invasive endoscopic access. In open surgery, the prostate is removed through an incision in the abdomen or via a perineal incision. Removal of the lymph nodes via the perineal incision is only possible to a very limited extent. With endoscopic access ("keyhole surgery"), a distinction is made between conventional laparoscopy and the robot-assisted procedure. The robot-assisted da Vinci procedure is used at the Goldstadt Private Clinic.

Prostate cancer mainly metastasises to the lymph nodes in the pelvis or the rear abdominal cavity (retroperitoneum). Other typical sites of metastasis are the bones, the lungs and the liver.

You can find information on prostate biopsy on this page.

Patients are admitted for robot-assisted da Vinci prostatectomy on the day before the operation. The operation takes place under general anaesthesia. The robot's minimally invasive instruments are inserted into the abdominal cavity using keyhole surgery. Under three-dimensional vision, the surgeon carefully dissects the prostate and then removes it completely with the attached seminal vesicles. Robot-assisted surgery allows particularly precise visualisation and preservation of the sphincter muscle. The associated lymph nodes are also removed. The urinary bladder is then sutured to the urethra above the sphincter and secured with a bladder catheter. Postoperative care takes place in the recovery room before the patient is transferred to the normal ward. The bladder catheter is removed after the tightness of the anastomosis (connection between the urinary bladder and the urethra) has been checked. The patient then empties the bladder on their own again. If this goes satisfactorily, the patient is discharged. The entire inpatient stay lasts approximately one week.

Thanks to 10x magnification of the surgical field, the anatomical structures (nerves, vessels, sphincter, etc.) can be visualised and preserved much better, making it easier to maintain continence and potency. Compared with conventional (open) surgical techniques, this results in less blood loss, less pain and a shorter hospital stay.

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In principle, robot-assisted da Vinci prostatectomy can be performed on any patient. In individual cases, pronounced adhesions in the abdominal cavity can be an argument for not performing robot-assisted da Vinci prostatectomy.

The use of the da Vinci robot allows particularly precise dissection 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 cancer, the nerve plexus required for erection can be preserved. The success of erection-sparing surgery depends on whether the erectile nerves can be spared on only one side or on both sides.

Directly related in time to the acute operation are the risk of anaesthesia, the risk of bleeding and the risk of inflammation. These risks disappear once the healing phase after the operation has been completed. The risk of incontinence and erectile dysfunction remains. With the surgical method of robot-assisted da Vinci prostatectomy, erectile function and continence can be preserved in many cases.

In radiotherapy, healthy cells of the surrounding tissue are irradiated as well as the cancer cells, because the rays also pass through healthy tissue on their way into the prostate. This causes damage to the bladder neck and the bladder wall (radiation cystitis). The erectile nerves can also be damaged, which can lead to a gradual increase in erectile dysfunction over the course of months after radiotherapy.

Radiation cystitis is damage to structures of the urinary bladder. This manifests itself in changes to the bladder mucosa, bleeding in the bladder and the development of an overactive bladder.