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PROSTATE CANCER TREATMENT - BLOODLESS PROSTATE SURGERY
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 | | DAVID B. SAMADI, M.D.
Chief, Division of Robotics and
Minimal Invasive Surgery
Mount Sinai School of Medicine |
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Surgeons who manage patients with prostate cancer must understand the advantages and disadvantages of each available procedure to optimize outcomes. The traditional open prostatectomy effectively removes cancer, but has been associated with longer and more painful hospitalizations, significant blood loss, incontinence, and sexual dysfunction. The more recently developed laparoscopic prostatectomy represents a major advance for patients with prostate cancer because it involves no incision, minimized blood loss and postoperative complications, and enables patients to recover more quickly with less pain. However, there is a steep learning curve associated with the laparoscopic approach; it will take about 100 procedures before the technique can be mastered. In addition, the camera used to visualize the surgical area is two dimensional, which can make achieving optimal visualization difficult.
Laparoscopic Robotic Prostatectomy Provides More Advantages
A recent addition to the surgical management of prostate cancer is robotic laparoscopic prostatectomy. The procedure has the same advantages associated with laparoscopic prostatectomy—no incision, minimum blood loss, fast recovery, and minimal catheter use—but the new technology uses robotic instrumentation and two cameras for better visualization. Using two cameras enables us to ascertain a three-dimensional view of the anatomy with greater magnification. And unlike laparoscopic prostatectomy, the robotic instrumentation provides surgeons with a full range of motion, and is associated with significantly less blood loss. For this reason, robotic assisted prostate surgery is sometimes called bloodless prostate surgery. In addition, sexual dysfunction and incontinence risks are reduced because the surgeon has a clear view of the anatomy; we can more accurately navigate around the nerves and structures responsible for these problems.
Some surgeons believe that they need to use their sense of touch and feel in order to effectively remove the cancer, but this is clearly a myth. Using our eyes can provide greater sensitivity than just using finger tips in prostatectomy procedures. The robotic laparoscopic approach gives us the added benefits of improved magnification and technology.
Thorough Training is a Must
Few surgeons in the United States are trained in all three prostatectomy procedures, but it can greatly benefit patient outcomes if experience is gained in each approach. Surgeons must be skilled at laparoscopy in order to be an excellent robotic surgeon, but they must also be adept at performing the open procedure in order to obtain experience with laparoscopy. We should view the robotic laparoscopic prostatectomy as a procedure that bridges open surgery and laparoscopy skills. There are few cases in which a laparoscopic procedure needs to be converted to an open surgery, but surgeons need to be prepared and trained to do as such if this situation arises.
A robotic laparoscopic prostatectomy should not be performed unless the surgeon is adequately knowledgeable on the prostate anatomy. Some cases may present with adhesions or scar tissues, so the laparoscopic surgeon will need to be capable of working within these conditions. This is why patient volume is so important and surgeons need to have performed at least 100 cases. If not, they’re still working through the learning curve and the patient’s outcome will not be maximized.
Exploring All Options With Patients
Surgeons should inform their patients about their experience with the prostatectomy procedures they perform. It is important to convey the training we have so that patient concerns about safety can be overcome. We also need to explore some of the myths and misconceptions that may be associated with each procedure so that they don’t interfere with the patients’ surgery selection. Another important aspect is to be compassionate with the entire family, not just the person with prostate cancer. There are many emotions involved for the patient and their supporting caregivers, and we should involve ourselves in that support.
© 2006 Physician’s Weekly |
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