Robotic surgery for prostate cancer
Assisted robotic prostatectomy is a way of doing surgery for prostate cancer. It is a type of keyhole (laparoscopic) surgery. It is also called da Vinci surgery. A surgeon does the surgery but uses a special machine (robot) to help. It is not available at all cancer hospitals in the UK. We don't yet know whether this type of surgery is better than other types of surgery for prostate cancer or whether it is cost effective. You have assisted robotic surgery in an operating theatre under a general anaesthetic.
Doctors need to have special training before they can carry out this type of surgery. It involves two machines
You lie on the operating table and the patient unit is beside you. The unit has 4 arms. One holds the camera and the others hold the surgical instruments. The surgeon makes 5 small cuts in your abdomen. The camera and instruments are put in through the cuts to do the surgery. The patient unit is controlled by the control unit.
The control unit is where the surgeon sits. It is in the operating theatre with you but is separate from the patient unit. The surgeon can see the operating area on a screen. This gives the surgeon a 3D view that they can magnify up to 10 to 12 times.
Below the screen are the controls. The surgeon uses these master controls to move the instruments on the patient unit. This turns any movements the surgeon makes into much smaller movements of the machine. It also reduces any shaking, allowing the surgeon to make very tiny, accurate movements.
Surgeons only started using these machines in 2000. A systematic review in early 2007 found that it was as good at removing the cancer as other types of surgery. But we don’t yet know how well these men do long term, compared to men having regular surgery.
In the review, robotic surgery had the same advantages as laparoscopic prostate surgery when compared to radical prostatectomy. There was
- Less bleeding
- Less scarring
- A shorter stay in hospital
- Quicker recovery
The review also found that if the surgeon was experienced, the operation appears to be as good as the standard radical prostatectomy in removing cancer with a border of healthy tissue around it. Doctors call this a clear margin.
Some studies in the review found that men were more likely to get their bladder control back quickly and were able to get an erection again sooner after this type of surgery. But the studies were small and weren’t randomised, so we don't yet know for certain if it is better than standard surgery at reducing the number of men who have side effects.
The usual way of having your prostate removed is either through
- A cut in your abdomen (retropubic prostatectomy)
- A cut between your testicles and your back passage (perianal prostatectomy)
- Keyhole surgery (laparoscopic)
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