Robotic Surgery for Prostate Cancer

What is Robotic Laparoscopic Surgery?

Robot-assisted surgery in prostate cancer treatment is a new innovation. It consists of using robotic equipment which, unlike what some patients may think, is fully controlled by the doctor. The robot replicates the surgeon’s movements (in a “master and slave” relationship), performing the very precise movements, or “orders,” they execute.

These very sophisticated pieces of equipment allow surgeons to remove the prostate and surrounding tissue accurately and precisely.

It is a variant of keyhole surgery, maintaining its essential benefits while making operations quicker, more delicate and more precise.

It is a far less invasive procedure than conventional radical retropubic prostatectomy which involves an abdominal incision from the navel to the pubic region.

For patients, it translates into a shorter recovery time and shorter hospitalisation.

For patients operated on and cared for at the Instituto da Próstata, the Da Vinci System is used.

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What is the Procedure?

The robotic surgery procedure and approach is very similar to conventional laparoscopy.

However, robotic surgery aids operations. It helps the surgeon, for example, in one of the most difficult and complex steps in laparoscopic radical prostatectomy: urethrovesical anastomosis using stitches (i.e. joining the urethra and bladder after removal of the prostate to re-establish the continuity of the urinary tract).

Before the operation, and in addition to the patient’s physical examination, a series of blood, urine and other tests are run. This assessment is complemented by radiology tests such as MRI scans, CT scans and possibly others (bone scintigrams, PET, etc.).

The procedure involves general anaesthetic and lasts around 2 hours.

In practice, the patient needs to know the following:

The surgeon can access the prostate via small incisions at strategic points;
The technique uses a video camera, which takes very high quality 3D images, that guides the surgeon’s work;
During surgery, the doctor sits at a console beside the patient and performs the operation using tiny instruments;
The surgeon’s movements are “replicated” by the robot.

Treatment is usually followed by a hospital stay of a few days.

When discharged, the patient must refrain from movements at home that entail physical exertion in the first few weeks.

Da Vinci System Characteristics and Benefits

Although the Da Vinci robotic system continues to be the most used system today, there are already several others, each with its own advantages and disadvantages.

Da Vinci robots usually includes several modules, such as the console (where the surgeon is located), the robot arm module and the imaging and video equipment. The robot's arms are used to reproduce, inside the patient, the movements of the surgeon's hands on the console. It constitutes the most pivotal and distinctive element of the equipment.

Unlike the classical laparoscopic tools (clamps, scalpels, needle-holders, etc.), these are not limited to 6 degrees of movement.

They can be moved in any direction in complex combinations without limitations.

The technique has various benefits, among which:

Amplified high-definition 3D images;
Better visualisation of anatomical structures.

For patients, the Da Vinci system has benefits compared to the traditional approach with regard to recovery time and the effects associated with the operation, such as:

Quicker control of the urinary sphincter (i.e. faster recovery from urinary incontinence);
Lower rate of hospital readmissions (versus open surgery);
Shorter hospital stays (versus open surgery).

Using robotics in this type of operation also cuts the risk of infection and blood loss.

Want to know more about this treatment?

Robotic laparoscopic surgery with the Da Vinci system is an innovative operation. It is minimally invasive, more precise and meticulous. Patients recover more quickly, because the technique is less aggressive than others.

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What is the Post-Treatment?

The first consultation is scheduled around 2 weeks to a month after the procedure.

Next, and unless there are reasons otherwise, the patient has consultations every 3 months for a year.

At these consultations, diagnostic tests are performed, such as PSA and a digital rectal exam, to assess the success of the treatment.

Depending on the tumour, namely how aggressive it is according to the Gleason grading, PSA and stage, it may evolve in various ways.

In the second year, consultations are usually held every 4 months. From that point onwards, if the patient is clinically stable, the period may be extended to every 6 months until the fifth year.

From the fifth year onwards, patients may be assessed at least once a year if clinically stable.

Dr. José Santos Dias

Clinical Director of the Instituto da Próstata

Bacherlor's Degree from the Faculty of Medicine at the University of Lisbon
Specialist in Urology
Fellow of the European Board of Urology
Autor dos livros "Tudo o que sempre quis saber Sobre Próstata", "Urologia fundamental na Prática Clínica", "Urologia em 10 minutos","Casos Clínicos de Urologia" e "Protocolos de Urgência em Urologia"

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