Prostatectomy is the surgical removal of the prostate gland and accessory glands called seminal vesicles. It is an effective treatment for men with early stage prostate cancer.
In the video series below, Dr. James Porter explains what prostate cancer is, how finding it early is the key to curing it, and the benefits of robotic prostatectomy.
Robotic prostatectomy is done in an operating room, with a specially trained surgical staff. Patients are under general anesthesia and are constantly monitored by an anesthesiologist.
During this procedure:
- The surgeon makes five small incisions, all about one-quarter inch
- Specially designed surgical instruments and a tiny 3-D camera are attached to robotic arms and precisely inserted through the incisions
- The surgeon sits at a nearby console, looking through a viewfinder and controlling every movement of the robotic arms
- The surgeon carefully separates the prostate from the bladder and then from the urethra; the urethra is then sewn back onto the bladder
- The nerves that control erectile function are carefully preserved as well as the urinary sphincter that maintains urinary control
- A catheter is inserted that will stay in place for seven days
- The prostate is placed in an impermeable bag and then brought out whole through one of the small incisions
- The instruments are removed, and the incisions closed
The prostate is removed whole so the entire prostate can be examined under a microscope by a pathologist. This pathologist can determine how much cancer is present, exactly where it is located and if it is contained within the prostate.
This information is used to determine if further treatment is necessary.
In a standard, open operation, a prostatectomy is done via an incision from the belly button to the pubic bone.
With an open procedure:
- Patients spend two to three days in the hospital
- Recovery may take up to four to six weeks
- The catheter inserted during open surgery remains in place for two weeks
In comparison, with robotic prostatectomy:
- The hospital stay is less than 24 hours
- Recovery is usually about two weeks
- The catheter is removed in seven days
Because of the view magnification of 10 to 15 times with the robotic scope and the improved precision of the robotic instruments, patients also benefit from:
- Less pain
- Earlier return of urinary control
- Improved erectile function
Radiation therapy can also be used to treat prostate cancer. One advantage of surgical removal of the prostate is the complete pathologic analysis of the prostate, which provides important staging information and allows additional therapy to be planned.
The major advantage of surgery over radiation is that if cancer recurs after surgery, then radiation is still a treatment option.
But if radiation is done first, surgery is typically not an option after radiation because of the significant risk of complications from the radiated tissues.
All surgeries involve some degree of risk, and discussing this with your doctor is an important part of preparing for any surgery.
The most common complication for open prostatectomy is excessive bleeding. In about 30 percent of open procedures, a blood transfusion is necessary. With robotic prostatectomy, a blood transfusion is needed in less than one percent of procedures.
Another complication seen after open prostatectomy is scarring at the junction between bladder and urethra. This is termed a bladder neck contracture.
With robotic prostatectomy, bladder neck contracture has been essentially eliminated due to improved suturing with the robotic instruments.
Robotic surgical systems are now widely available, but that does not mean every surgeon has the experience needed for consistently positive outcomes.
While the robotic technologies are vastly superior to other surgical tools, the experience of the robotic surgeon is paramount.
When you interview robotic surgeons you are considering, but sure to ask:
- How many robotic procedures they have performed
- How many robotic prostatectomies they have done
- How long robotic surgery has been available at the hospital
- The overall volume of robotic surgery at the hospital
At Swedish, our urologic robotic surgeons are the most experienced in the Northwest and among the most experienced in the country. They have published the results of their robotic surgeries, and teach robotic methods to robotic surgeons from other medical centers.
More than 1,500 robotic prostatectomies have been performed here, and everyone on our robotic surgery teams, including the anesthesiologist and nurses, are specially trained and highly experienced in robotic surgery.