ROBOTIC SURGERY
FOR EARLY PROSTATE CANCER
WHAT YOU NEED TO KNOW
IN A NUTSHELL :
Prostate cancer is one of the most common cancers affecting men today . Surgery to remove cancerous prostates is widely performed using robotic surgical instruments through the minimally invasive approach .
Robotic surgery performed in experienced hands delivers less pain , less blood loss , shorter hospital stays , and earlier return of daily function , compared to open surgery .
Most prostate cancer patients undergoing robotic surgery will experience significantly less bleeding and pain compared to conventional open surgery . In straightforward cases , patients are typically discharged from the hospital two or three days post-surgery .
THE PROSTATE is a walnut-sized gland existing in the male reproductive system , found below the bladder in the male pelvis . Prostate cancer remains the most common cancer among men in the United States , Europe , and Australia . In Singapore , it is the third most common cancer among men and is typically diagnosed in men above the age of 50 , or with a family history of prostate cancer , putting them at increased risk .
Prostates cancer typically does not cause any symptoms in its early stages . It is therefore detected by finding an abnormally raised serum prostate-specific antigen ( PSA ) level , followed by an ultrasound-guided needle biopsy , to confirm or exclude the presence of cancerous cells in the prostate . With PSA blood tests becoming increasingly accessible over the last 20 years , the majority of men with prostate cancer are now diagnosed at an early , curable stage .
WHAT IS ROBOTIC SURGERY ?
Robotic surgery refers to the usage of a robotic surgical platform , known as the da Vinci ® Surgical System ( Intuitive Surgical , Sunnyvale , USA ), to perform laparoscopic , minimally invasive surgery through nanoscopic incisions . Since its inception in 2002 , robotic prostatectomy has become increasingly popular around the world . In Singapore and the United States , 90 % of all surgeries to remove cancerous prostates are now performed using the da Vinci ® Surgical System ( Intuitive Surgical , Sunnyvale , USA ).
This innovative technology comprises of a surgical cart that is docked next to the operating table , connected to small ports placed through incisions of < 1cm in the patient ' s abdomen . Robotic wristed instruments are then put through these small ports into the abdomen , which are controlled by the surgeon sitting at the operating console , a safe distance away from the operation table ( Figure 1 ). A binocular camera is then used , giving the surgeon a three-dimensional view of the operating field , which can then be magnified up to 12 times . The surgeon then adjusts the camera lens and the various robotic instruments at the console through the use of hand controls and pedals . These strategically designed instruments give the surgeon excellent precision and dexterity of surgical movement , through the patented robotic wrist technology .
WHAT HAPPENS DURING ROBOTIC PROSTATECTOMY ?
During a robotic-assisted radical prostatectomy , the patient is put under general anesthesia , and surgical ports are placed through six keyhole incisions of < 1cm in the abdominal wall . Through the < 1cm ports , robotic instruments are placed ( Figure 2 ). The bladder , prostate , and seminal vesicles , are dissected free from surrounding structures . The vas deferentia ( tubes carrying sperm from the testicles are disconnected on both sides , and the prostate and seminal vesicles are removed after securing the blood vessels supplying these structures .
The bladder is then sewn to the urethra using sutures , and a urinary catheter is left in the bladder for five to seven days to allow adequate healing .
In cases of low-risk prostate cancer , surgeons typically attempt to spare the nerves controlling erectile function and urinary control during surgery , to facilitate earlier recovery of these vital functions .
Patients aged less than 65 years with no other significant health issue derive the easiest surgical and recovery routes .
Figure 1 . The da Vinci Surgical System comprises a patient cart docked next to the patient ont he operating table , while the surgeon operates from a console some distance away .
Dr . Gerald Tan Yau Min is an urologist specialist at Advanced Urology with over 23 years of clinical experience with a record of 1,500 robotic radical prostatectomies performed . He is internationally renowned for his expertise in minimally invasive and robotic surgery for prostate , kidney and bladder diseases . He may be contacted via email at enquiry @ urology . com . sg .
Figure 2 . Illustration of conventional scar versus robotic keyhole scars for prostate cancer surgery .
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