An Overview of Robotic Prostatectomy

Prostatectomy is a surgical procedure to remove either all of, or part of, the prostate gland, usually to treat benign conditions in the prostate, or to treat localised prostate cancer and other pelvic cancers.

The prostate gland is a part of the male reproductive system. Its main role is to produce the fluid that carries and protects sperm. It is located in the lower abdomen in men only.

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There are two main types of prostatectomy, depending on the condition being treated:

Radical — A radical prostatectomy involves removing the entire prostate gland, capsule (or covering), the surrounding lymph nodes and neighbouring tissue. This is usually a treatment for men with localised prostate cancer.

Simple — A simple prostatectomy is when an enlarged prostate is removed by enucleating it from its capsule. The sphincter muscle and surrounding nerves remain intact. It is used to treat benign conditions such as enlargement of the prostate (benign prostatic hyperplasia or BPH).

What Is Robotic Prostatectomy?

Robotic prostatectomy is a surgical method for operating on the prostate using small tools that are attached to a robotic system. Rather than the surgeon performing the procedure with their own hands, they control robotic arms with a computer. Robotic prostatectomies are far less invasive than traditional surgery and have many advantages and health benefits.

How Does It Work?

A robotic prostatectomy is performed by a surgeon who sits at a computer station and directs the movements of the robotic arms via a computer interface.

The robot’s camera and instrument-bearing arms are inserted through several small incisions in the abdomen. The prostate is detached internally, placed in a bag, then removed through one of the incisions.

Advantages of Robotic Surgery

Robotic prostate surgery has a wealth of advantages over traditional laparoscopic or open surgery. The technology used in robotic surgery enhances precision, control and flexibility of the surgeon’s movements which means the surgery is far less invasive.

• Instruments used in robotic prostatectomy can turn in all directions with 90 degrees of articulation

• The system can operate through much smaller incisions — just 1 or 2 centimetres

• The robotic system allows the surgeon a true 3D view of the operating field. This hand-eye instrument alignment is similar to open surgery only with all-around vision, the ability to zoom-in out and without the invasive side effects of open surgery

• The surgeon is able to sit comfortably at the computer station, meaning they can concentrate fully on the task at hand

These factors contribute to a far less traumatic experience for patients undergoing prostate surgery. Recovery is much quicker and the precise movements of the robotic system mean that the delicate nerves and organs surrounding prostate are spared. Risk of harm to bladder control and erectile function is greatly reduced.

Risks

As with any surgery, there are risks associated with a robotic prostatectomy, although each is dramatically reduced by robotic surgery. These include:

• Surgical complications such as blood loss, infection and deep vein thrombosis

• Incontinence — urinary function is controlled by two muscles which are located around the prostate, so surgery may cause incontinence until these muscles regain their strength.

  • Erectile dysfunction — operating on cancer of the prostate will always hold the risk of postoperative erectile dysfunction as many of the nerve bundles that control erectile function are affected during surgery. However, robotic surgery, if carried out early, dramatically reduces the risk of erectile dysfunction.

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