Department of Urology

Robotic-Assisted Laparoscopic Radical Prostatectomy

Overview

The da Vinci Surgical System is designed to overcome some of the deficiencies of traditional laparoscopic surgery and provide the surgeon with a close approximation of feel of traditional open surgery in a minimally invasive environment. The surgeon sits at a console away from the surgical field while an assistant works at the patient’s side.

The surgeon views the procedure through a camera with the binocular Insite vision system. This system gives the surgeon a three dimensional view of the operation. By positioning the endoscope close to the operative field, high magnifications can be achieved.

The surgeon controls the robotic arms and camera through a system of wrist controls and foot pedals. The robot instruments are designed to function in a manner similar to the human wrist, which allows complex maneuvers to be performed effortlessly. The system can be scaled up or down to facilitate complex microsurgical techniques. Hand tremor is automatically eliminated by the system. The instruments may be quickly switched to enable different functions such as grasping, cutting, coagulating, and sewing.

Advantages

  • Bleeding is reduced
  • Visualization and magnification are improved
  • Hospital stay is reduced
  • Recovery is faster

Disadvantages

  • Loss of tactile sensation (feel)
  • May not be optimal for certain body builds or people who have had previous abdominal or pelvic surgical procedures

Effectiveness

Are the results better than with traditional laparoscopic surgery?

We believe that the most important determinant of surgical outcome is the quality of the surgeon. Robotic instrumentation aids in performing the procedure, but cannot compensate for poor technique or lack of experience. In most cases we believe that the chances of curing the cancer, maintaining urinary continence, and preserving erectile will be similar when performed by experienced open or laparoscopic surgeons. Extensive experience with open surgical techniques does speed learning of the robotic assisted technique.

Risks

Are there cases where Robotic Assisted Laparoscopic Radical Prostatectomy is not recommended?

If a man is not a surgical candidate for health reasons, he is not a candidate for this procedure. There are situations in which the procedure is more difficult. Examples include overweight patients, men with very large prostates, and men with a history of extensive pelvic or abdominal surgery.