On this page:
The da Vinci Robotic Surgical System
Monterey Bay Urology Associates are the first urologists in the Monterey Bay Area to perform minimally-invasive, robot-assisted laparoscopic prostate cancer surgery. Our urologists have experience with well over 1000 prostate cancer operations, and have been performing Robot-Assisted Laparoscopic Prostatectomy since January 2003 with outstanding results. Our patients can now receive the benefits of prostate cancer surgery with much less pain, faster recovery, and the best results possible. Click here to request a consultation with one of our surgeons, or call either office to make an appointment. (Santa Cruz 831-476-2626 Watsonville 831-728-4227.
Robot-Assisted Laparoscopic Prostatectomy
Robot-assisted Robot-Assisted Laparoscopic Prostatectomy is an operation to remove the entire prostate in order to cure prostate cancer. It is essentially the same operation as open radical prostatectomy, except that the surgery is performed through 5 small puncture holes in the abdomen instead of a six inch incision from the pubic bone to the belly button. Laparoscopic surgery is used for many operations in general and gynecologic surgery, and is now the standard way of performing kidney surgery because patients recover much quicker with less pain. The first Laparoscopic Prostatectomy was performed in 1991, and it is now performed by laparoscopic urologic surgeons around the world. Our urologists are the first urologists in the Monterey Bay area to use the da VInci Surgical System, an advanced robotic surgical system that allows the surgeon to perform the most precise surgery and achieve the best surgical results possible. Click here to learn more about this advanced surgical system.
5 small incisions for laparoscopy instruments
Robot-Assisted Laparoscopic Prostatectomy is performed with a telescope inserted through a small incision below the belly button. The telescope is held by one of the arms of the da Vinci robot. The robot can make precise movements and provides magnification of the surgical field that allows more precise surgical movements. Four other small incisions are made so that surgical instruments can be passed into the abdomen to perform the surgery. The da Vinci robot is used by the surgeon to perform the precise movements required for prostate surgery. The telescope provides a very magnified view of the prostate, urethra, and penile nerves which allows precise, delicate surgery to be performed. The prostate is separated from the bladder, urethra and rectum in an identical fashion as in open radical prostatectomy. The prostate is placed into a bag at the end of the operation and taken out through the opening below the belly button.
"erection" nerves run along side of prostate
There are a number of advantages of Robot-Assisted Laparoscopic Prostatectomy compared to open surgery. Patients have much less pain after laparoscopic surgery, and most of our patients are able to leave the hospital the next day after surgery. The blood loss during laparoscopic surgery is 1/10 the amount of blood loss during open surgery, so patients have a lower risk of transfusion and leave the hospital feeling stronger and with a higher blood count. During Robot-Assisted Laparoscopic Prostatectomy we are able to make a very precise surgical connection between the bladder and the urethra with 10-12 fine sutures compared to 4-5 sutures placed during open surgery. Because of this we can remove the catheter in 7 days after Robot-Assisted Laparoscopic Prostatectomy compared to 14-21 days after open surgery, We also believe that Robot-Assisted Laparoscopic Prostatectomy allows more gentle handling of the prostate, urethra, and nerves so that patients recover urinary control and sexual function quicker than after open surgery. The main disadvantage of laparoscopic surgery is that it takes longer than open radical prostatectomy (3-5 hours compared to 2-3 hours).
incision for open radical prostatectomy
The risks of Robot-Assisted Laparoscopic Prostatectomy are essentially the same as the risk of open radical prostatectoomy, except that in many cases the risk is much less. The ability to cure prostate cancer appears to be exactly the same as with open surgery. The immediates risks of laparoscopic surgery include pain, infection, bleeding, need for transfusion, injury to abdominal organs, blood vessels, or nerves, blood clots in veins of your legs, and others. There is also the very small risk that conversion to open surgery may be necessary if there is bleeding or if the surgery cannot be completed with laparoscopy. The long-term risks of Robot-Assisted Laparoscopic Prostatectomy are the same as open radical prostatectomy. These include a 5% or smaller risk of urinary incontinence, and a moderate risk of erectile dysfunction. The risk of ED varies according to patient age, health, and the quality of the erections prior to surgery. We believe that the risks of incontinence and ED are the same regardless of which surgery is chosen, and we think that the recovery may be quicker after Robot-Assisted Laparoscopic Prostatectomy in many cases.
Most men with prostate cancer are potential candidates for Robot-Assisted Laparoscopic Prostatectomy. Men must be able to tolerate general anesthesia for 3-4 hours, so men with serious breathing problems are not good candidates. Men who have had multiple abdominal surgeries or who have very large prostates may be better suited to open surgery.
Most patients wake after surgery with very little or no pain. During the surgery the table is tilted so the patient's head is much lower that his feet, and most men have swelling of the face that resolves over the first night. Men can eat the next day and are able to easily walk and take pain pills. Men will have a catheter, which is a tube that enters through the urethra and drains the urine, for 7 days after surgery. Most men will have a pelvic drain for 1-2 days, which is a tube that lays deep in the pelvis where the prostate was removed and collects any fluid that may collect in the pelvis. Most men can return to light activity within 7 days of surgery and full physical activity within one month. Almost all men will have a small amount of urinary leakage for some time after prostate surgery and will need to use a small pad in the underwear. By 3 months after surgery more than 50% of men no longer need pads, and by one year more than 95% of men no longer have urinary leakage. The return of sexual function takes longer than the return of urinary control, and can take 6-24 months to return to normal. Men can use medications for ED as soon as they have recovered from the surgery and wish to try to resume sexual activity.