Robotic Surgery Flashcards
what is the prostate?
- male sexual gland
- adds nutrients and fluids for sperm
- this fluid is added to sperm during ejaculation
- urethra (urine channel) runs through the middle of the prostate
what is prostate cancer?
- abnormal cells growing out of control
- spreads and invades local tissues
- prostate cancer
- begins with a small tumor in the gland
- first spreads to the local lymph nodes
- then spreads to the bony skeleton and other areas of the body
Prostate Cancer Facts
prostate cancer
-leading type of cancer in men
-second leading cause of death in American males
-over 30k deaths each year in U.S
early detection
-best prognosis is early detection
-recent data on lower mortality rates of prostate cancer (40% reduction in mortality over last 30 yrs)
-affords patients many options for treatment
what is the relationship between prostate cancer and race?
incidence and mortality rate are higher in black than white
what are some early detection methods?
- digital rectal exam
- prostate specific antigen blood test (PSA)
- any abnormality in the PSA or DRE will require
- biopsy of the prostate
- ultrasound guided
- usually performed in the office
biopsy results
- prostate cancer graded on appearance of cancer cells
- gleason grading system
- gleason grade ranges from 1 (least aggressive) to 5 (most aggressive)
- gleason score (2-10)
- most common cell grade (first) added to second most common cell grade
- i.e Gleason 7 (3+4)
what do treatment options depend on?
- stage of disease
- patient’s age and health (comorbidities)
- patient’s personal preference
what are the treatment options (early diagnosis)?
- watchful waiting
- external beam radiation therapy
- brachytherapy (radioactive seeds)
- cryosurgery (freezing prostate)
- surgery (radical prostatectomy)
- open prostatectomy
- conventional laparoscopic surgery
- robotic assisted prostatectomy
robotic surgery
- allows for minimally invasive therapy GU malignancies
- less blood loss
- quicker convalescence and return to daily routine
- equivalent cancer control
- reduces the comorbidities associated with prostate surgery (i.e. continence and potency)
who is a candidate for robotics?
- men age 40-70 with localized prostate cancer
- no evidence of metastatic disease on evaluation
- prior abnormal surgery is a relative contraindication:
- AAA or prior aorto-bifemoral bypass
- complex colorectal surgery (LAR, APR, diverticular abscess, colostomies)
- prior prostate surgery or pelvic XRT
what are the goals of radical prostatectomy?
- remove the prostate and cancer
- high cure rates for localized disease
- preserve urinary function
- preserve erectile function
- analyze the prostate after surgery to assess risk of recurrence of cancer
nerve-sparing prostatectomy
- preserves nerves responsible for erections
- nerves run alongside prostate
- the da vinci system permits surgeon to spare nerves
- superior visualization
- high resolution 3-D image
- endowrist instruments
laparoscopic surgery
- minimally invasive surgery
- ability to operate through small keyhole incisions
- camera and instruments fit through the keyhole incisions
- better visualization than open surgery
conventional laparoscopic surgery drawbacks
- 2-D flat image video
- rigid instruments- chopsticks
- instruments controlled at a distance- fulcrum effect
- decreases your surgeon’s precision, dexterity and control
- higher surgeon fatigue
- makes complex operations more difficult
how does robotics overcome the drawbacks?
- provide a high resolution 3-D color image
- interpose a computer between the surgeon’s hand and the instrument tip
- increase the surgeon’s dexterity for the difficult aspects of the procedure
- sparing the nerves to preserve erectile function
- preserving continence
- preserving quality of life
what is the da vinci surgical system?
- powered by state-of-the-art robotic technology
- surgeon is in control and operates at the console
- assistant surgeon is next to the patient
vision system
*surgeon is immerse in 3-dimensional image of the surgical field
the surgeon directs the instruments
*the surgeon’s hands are placed in special devices called masters that direct the precise instrument movements
wrist and finger movement
- traditional laparoscopic instruments are straight and do not bend
- endowrist instruments move like a human wrist
- allows increased dexterity, maneuverability, and precision
small instruments through keyhole incisions
- da vinci surgical system endowrist instruments are small and are able to fit through keyhole incisions
- a wide range of instruments are available
what are the benefits of da Vinci prostatectomy?
- decreased blood loss
- shortened length of hospital stay
- decreased postoperative pain
- less scarring
- shorter urinary catheter time
- faster return to regular activities
- anticipation of improved potency and continence
what are the differences between robotic-assisted surgery and the traditional open procedure?
- in the open procedure, we have to make a long incision down the center of the abdomen
- in the robotic-assisted procedure, we make several small “key hole” incisions. these access points allow us to insert a high-powered 3-dimensional camera as well as robotic instruments into the abdomen. We can now see, under high-magnification, the prostate and surrounding anatomy. we can then perform a precise & delicate operation with the robotic instruments
compare the benefits of the two procedures
open procedure *long incision *hospital stay of 3.5 days *blood loss 900 mL *catheter removal 14 to 21 days robotic-assisted procedure *5 or 6 small keyhole incisions *hospital stay of 1.2 days *blood loss 153 mL *catheter days 5 to 7 days
what are some potential complications?
- essentially the same as with open prostatectomy
- greatest difference is that an open prostatectomy is performed retroperitoneal
- while robotic and lap are intraperitoneal
