Different treatment modalities are available for localised prostate cancer, although surgery with removal of the prostate remains a well-established treatment option for many men. Its major advantages include durable long term cancer control and minimal impact on bowel function. Like all treatment options, there is potential impact on urinary and sexual function.
The techniques for removal of prostate cancer have been refined over many years and it is well established in modern urological practice. Developments over recent years have aimed to reduce the potential negative effects of treatment, while maintaining good long term cancer control. The major development has been minimally invasive or keyhole surgery, which is used to treat many abdominal and pelvic conditions. A specific technological development with the introduction of a surgical operating system, known as the da Vinci robot, has refined keyhole surgery further. Techniques have been developed in particular to improve techniques for prostate surgery. http://www.davincisurgery.com/
What are the benefits of robotic prostatic surgery?
The recognised short term benefits are earlier hospital discharge and return to physical activity, earlier removal of urinary catheter, and reduced blood loss and reduced analgesia. On average men remain in hospital on average 2 nights, with a urinary catheter in place facilitating healing of the urinary outflow, for 7 days.
Potential long term benefits are improved recovery of urinary and sexual function, and improved cancer control. Research has not yet clarified how significant these potential long term benefits are, with long term studies ongoing. The most detailed comparative studies to this time indicate medium term improved recovery of urinary and sexual function, with long term followup awaited.
How is it performed?
As a keyhole (laparoscopic) operation, it requires general anaesthesia wit multiple, usually 6, telescope and instrument port sites placed through the abdominal wall. This specific technology allows extreme dexterity in handling the surgical instruments, as well as 10 power binocular magnification. See demo. This facilitates prostate cancer surgery, both for removal of the prostate, and pelvic lymph glands in appropriate cases. These features also facilitate sparing of the erection nerve mechanism (nerve-sparing surgery), and allow a precise urinary reconnection or anastomosis. The cancer containing prostate is placed into a purpose built, sealed surgical pouch and removed via one of the abdominal port sites for routine, careful pathological analysis.
The surgery takes a similar time to incision based radical prostatectomy (approximately 2-3 hours).
Our Robotic Surgical Program
Dr Roger Watson was a founding member of Queensland Robotic Surgery, as the first Robotic surgical unit in Brisbane, based at Greenslopes Private Hospital, when it commenced in 2008. It remains a unit of highly trained robotic surgeons having performed over 2000 robotic prostatectomies. A review of outcome data relating to recovery and cancer followup he recently presented at the ANZUP annual scientific meeting, showed the benefits of robotic surgery for prostate cancer.
The robotic surgical programme extended his subspecialty urological cancer training, which started in 1990. This programme of robotic surgery is complimentary to his practice focused on all forms of urological oncological surgery, including incision based surgery.
Robotic surgery for bladder cancer (removal of the urinary bladder with urinary reconstruction) remains in development.