Ask the Expert: Robotic Prostate Surgery

According to the American Cancer Society, prostate cancer is among the most commonly diagnosed cancers, affecting one in six U.S. men. Today, due to early detection and aggressive monitoring and treatment, prostate cancer survival rates are among the highest of any cancer. Men have many treatment options available to them; including radiotherapy, cryotherapy and surgery — the latter being the only treatment that removes the cancerous prostate. Da Vinci® robotic surgery offers patients a highly effective, minimally invasive option for removal of the prostate. 

Dr. Julian Anthony is a urologist affiliated with Sharp Grossmont Hospital, and one of the experienced surgeons specially trained to perform surgeries using the da Vinci robotic surgical system. He answers questions about this revolutionary new treatment.

How does da Vinci prostatectomy differ from traditional surgery?
Traditional surgery for prostate cancer has involved an incision made from just below the belly button to the pubic bone. The da Vinci prostatectomy involves five dime-sized holes through which instruments and a camera are inserted to perform the procedure. The instruments and camera are then connected to the da Vinci robotic system, which the surgeon controls while sitting at a console positioned next to the operating room table.

Postoperative pain is less with the da Vinci prostatectomy because of the less invasive incisions. As a result, patients use less pain medication, have a shorter hospital stay, return to normal activities and work sooner and have their catheters removed sooner. This also results in less blood loss and need for transfusion as compared to traditional surgery.

Besides prostatectomy, what are the other common urologic conditions that can be treated with robotic surgery?
Removal of urinary organs for cancer is a common application for robotic surgery. This includes removal of the adrenal glands, ureters (the tubes that connect the kidneys to the bladder), bladder, kidneys or any portion of the kidney that contains cancer (partial nephrectomies). Reconstruction of the kidney for blockage and removal of lymph nodes can also be treated with robotic surgery.

Does da Vinci prostatectomy result in a higher cancer cure rate than conventional surgery?
Yes, it does result in a higher cancer cure rate when compared to open surgery. The da Vinci system’s magnified and 3D high-definition image provides better visualization for the surgeon. This results in a lower rate of positive margins because the surgeon is able to better differentiate between normal prostate, prostate cancer and surrounding tissues. The surgeon is then able to do a better job of removing all of the cancer and leaving normal surrounding structures uninjured.

What physical limitation will I have after the operation and when will I be able to resume activities, such as working, driving and exercising?
Return to preoperative activity is around two weeks. This does depend on the patient’s preoperative health and medical conditions. Patients have a catheter in the penis after the operation for five to seven days. This facilitates the healing of the reconnection between the bladder and the urethra after the prostate is removed. Patients may shower 24 hours after the procedure, but they should avoid lifting more than 15 pounds for the first 2 weeks after the operation.

How soon can I expect to have erections and intercourse after surgery?
Erectile function and the ability to have intercourse is dependent on several factors, including your preoperative erectile function and the extent of your prostate cancer. The extent or stage of the cancer dictates how aggressive we can be in sparing the nerves responsible for erectile function. Patients with a low PSA and a low volume and grade of disease are candidates for an aggressive nerve-sparing procedure on both sides. If such a candidate was able to attain unassisted erections adequate for sexual intercourse preoperatively, they could expect to have erections and intercourse anywhere from six weeks to one year after surgery. This significant range in return to function reflects the many factors involved in erectile function.

Does da Vinci cost more than traditional surgery, and does insurance cover it?
No, robotic-assisted surgery does not cost the patient any more than traditional surgery and insurances does cover it.

For More Information
To learn more about Sharp's robotic surgery services in San Diego, register for a free robotic surgery seminar. To find a Sharp-affiliated physician performing robotic surgery, call 1-800-82-SHARP (1-800-827-4277), Monday through Friday, 8 am to 6 pm.