Robotic Prostatectomy

Robotic Radical Prostatectomy
Dr Chin Chong Min

Fig 1:Console of the da Vinci robot

The first robotic prostatectomy was performed in 2000. Since then, thousands of robotic prostatectomies have been performed around the world, from USA to Europe, and now, Asia. By 2004, robotic assistance was used in nearly 10% of all radical prostatectomies in the United States. By 2010, this proportion increased to almost 90%. The exponential growth is due to the advantages provided by the Da Vinci robotic system (Intuitive Surgical, Inc., CA, USA) which allow the surgeon to sit comfortably at a console and operate with 10-fold magnified, 3-dimensional vision. (Figure 1) Open radical prostatectomy does not confer such a stereoscopic, magnified view. Furthermore, the narrow male pelvis gives limited space for suturing of the bladder to the transected urethra after the prostate is removed. On the other hand, the Da Vinci system is ideal in such a confined space; it controls up to three robotic arms with its small articulate instruments to reproduce the surgeonís wrist movements (Figure 2) These robotic instruments have seven degrees of motion compared to four degrees with conventional laparoscopic instruments (Figure 3). Unlike conventional laparoscopic method, the surgeon is also in direct control of the camera and aided by computer-filtration to eliminate hand tremor and fine-scale hand motions. The only technical disadvantage is the lack of tactile feedback. However, with the help of a regular team, this is not a major handicap. The surgery takes 3 to 4 hours.

robotic arms

Fig 2: Robotic arms in place

Fig 3: Robotic instruments in motion

In terms of clinical outcome, clear benefits of robotic surgery are reduced postoperative pain and length of hospitalisation. Patients can be discharged as fast as the second post-operative day. Decreased blood loss is the other advantage, the blood loss being less than 200 ml on average. Hence, transfusion rates for robotic method is negligible compared to open surgery. The other concerns that patients have is incontinence and impotence. Here again, the robotic method allows the surgeon to better preserve the urinary sphincter and the nerves that control erection, thanks to the magnified 3-dimensional vision. Data from many centres show faster return of continence and potency. Not surprising, there is a trend for patients to travel to leading hospitals that offer robotic surgical technology. This emerging trend can be attributed to the measurable clinical benefits that robotic-assisted radical prostatectomy offer despite the higher surgery cost.

Robotic prostatectomy is the fastest-growing treatment for prostate cancer in most Western countries. With more men being diagnosed with early prostate cancer here in Asia, the number of robotic surgeries is increasing. The advantage to patients who opt to have their surgery here is the relatively lower cost.

This animated video shows how da Vinci robotic prostatectomy is performed