The aim with this surgery is to achieve complete removal of the cancer whilst preserving urinary control and erection function - the trifecta. As one of Australia's most experienced robotic surgeons, I perform more than 200 cases each year.
The DaVinci robot is controlled using two joystick-like arms and several foot pedals. These controls move robotic arms that can be fitted with a variety of different tools. Typically an incision of one to two centimeters allows three or four arms to enter into the patient's body.
The controls then convert every five inches of my movement to one inch of movement inside the patient – this allows for improved fine motor actions. In the theatre I sit at a station and use the built in 3-D monitor for vision to complete the surgery.
Advantages of robotic prostatectomy
The DaVinci robot has revolutionised surgery and thousands of patients have benefited from the use of this technology. With miniature incisions and a laparoscopic approach robotic surgery offers:
- Quicker return to normal activity
- Shorter hospitalisation
- Reduced risk of incontinence and impotence
- Less blood loss
- Reduced pain, most patients do not require pain medication after discharge.
This state-of-the-art surgical procedure can offer the best chance for complete recovery. Wristed instrumentation, tremor filtration and 3D magnification aid in performing one of the most demanding aspects of the procedure — nerve-sparing for preservation of sexual function and continence.
Who can have robotic surgery?
Some patients are better suited for robotic surgery, however the prostate cancer must be confined to the prostate gland.
Patients who have had a stroke or cerebral aneurysm are not candidates for robotic prostate surgery, as the surgical table is titled head-first at a 45° angle for the one to three hour procedure. And some cardiac and pulmonary disorders exclude patients from robotic prostate surgery such as angina, congestive heart failure, severe restrictive lung disease, asthma or cardio-obstructive pulmonary disease and any condition requiring supplemental oxygen.
Other factors include severe glaucoma, hip disease or a disorder that's not compatible with the surgical position and obesity.
When can I have sex?
It is recommended to wait four weeks before having sex. Please remember that most patients will be able to climax but there will be no ejaculate.
When can I return to work?
Most patients are able to return to work within one to two weeks and nearly all activity can be resumed by four weeks. Men with occupations that require heavy lifting will need to be on light duties for four to six weeks.
When will I know if all the cancer has been removed?
I will assess recovery, remove the catheter and review the final pathology report with the patient at the first follow-up appointment, which are usually four to seven days after surgery.
When will I be able to have an erection again?
Everyone is different. Some patients start having erections very soon after surgery while others take up to two years. However, my team has consistently demonstrated superior outcomes with the maintenance of sexual function. Each patient is encouraged to see the nurse at my practice who will answer questions.
Why a Robotic Radical Prostatectomy?
Traditional radical prostatectomies require either a large incision with unpleasant side effects or feature limited vision and dexterity. At St Vincent's, I can provide the best opportunity for full recovery from prostate cancer. Experience demonstrates that a robotic radical prostatectomy successfully overcomes these shortcomings and offers patients improved benefits, including minimal risk of incontinence and impotence.
Why should I choose St Vincent's Private Hospital?
St Vincent's Private Hospital was the first hospital in NSW to perform a DaVinci robotic radical prostatectomy in 2005 and today we have the latest model of the machine. The early adoption of this highly advanced laparoscopic prostate cancer treatment demonstrates its commitment to providing world-class healthcare.