The treatment of prostate cancer with the laparoscopic approach, especially by means of robotic-assisted laparoscopy, is slowly gaining acceptance throughout the world. Based on our experience, robotic prostatectomy for prostate cancer is clearly the more beneficial approach when compared to conventional open surgery. It is especially optimal for the medical traveler who requires a quick recovery.
The robotic prostatectomy procedure involves the surgical removal of the prostate gland through the use of the da Vinci Robotic Surgical System, which is composed of 3 major components: the camera which allows the surgeon to view the area being operated on; the robotic arms and instruments the surgeon uses to operate with; and a unique worktable where the physician views the surgical site and maneuvers the robotic arms from a remote location. The robot serves as an extension of the surgeon’s hands and eliminates the need for large incisions that are necessary in open surgery.
The first step in the process is for the surgeon to make a few small, dime-sized incisions in the patient’s abdomen. Then, small plastic tubes are placed in the incisions to keep them open while a tiny camera (laparoscope) and small robotic arms are inserted. The surgeon then maneuvers the laparoscope and robotic arms to remove the prostate gland. The procedure takes 1 to 2 hours typically.
There are several advantages to robotic prostatectomy. First, incisions are much smaller than open surgery and the surgeon has very precise control through the use of small robotic arms and tools. Comprehensive cancer control is enhanced because the robotic tools the surgeon uses afford a much clearer and magnified view of the prostate. This allows the surgeon to perform various nerve sparing techniques-so called the “Veil of Aphrodite.”
Because the nerves around the prostate enable bladder control and erectile function, this advanced nerve-sparing procedure allows the patient to have better bladder control and a quicker return to sexual activity after surgery. Also, because of the small incisions, nerve sparing techniques and faster healing, pain is minimized and the patient is able to return to his or her normal activities more quickly. If the patient’s job involves long periods of sitting, he or she may return to work within 1-2 weeks. More strenuous working conditions may take up to 4-6 weeks.
Since July of 2005, our team has performed more than 500 robotic prostatectomies, with 97.2% of cases maintaining proper bladder control and 40.8% who showed perfect control during their 6-month follow-up. Also, 53.4% of our patients who were under 65 years and preoperatively potent returned to normal sexual functioning 6 months following the procedure.
Robotics is becoming the future of surgery, especially in the field of urology. Through delicate movements of the robotic arms, a surgeon has improved ability to spare the bladder and penile nerves, thus providing the patient with enhanced sexual and bladder functioning over the conventional open surgery approach.
Outside of urology, robotics has been expanded to cardiovascular, thoracic, gynecology and general surgeries, thus creating a new era in surgical intervention. With more than 1200 cases to date, our da Vinci program boasts the largest experience in the world among many cancers, including stomach, thyroid and colorectal cases. A robotic training center has also been established to further enrich this growing field.
Dr. Koon Ho Rha is a surgeon at Severance Hospital and Associate Professor of Urology at the Yonsei University College of Medicine in Seoul, South Korea. Upon completing his M.D. at Yonsei, Dr. Rha completed training in robotic and minimally invasive laparoscopic surgery at Johns Hopkins as an Engineering and Urology Endowed Fellow. He is skilled in advanced, complex laparoscopic surgical techniques including both retroperitoneal and transperitoneal methods and has extended his specialty to robotic surgery. He currently serves on the board of numerous international minimally invasive and robotic professional groups including the World Minimally Invasive Robotic Association (MIRA), Society of Urologic Robotic Surgery (SURS) and Engineering and Urology (E&U). He is also associate editor of the Journal of Robotic Surgery.