Finding out you have prostate cancer may be one of the hardest things you’ve faced. That’s why it’s important to learn the facts about your condition before choosing the best path forward. You may also want to ask your doctor about how the nerves around your prostate gland can be protected. These nerves help to control urinary and sexual functioning.
Know Your Options
Having surgery to remove part or all of your prostate is called a prostatectomy. This can be done as an open surgery (through one large incision) or as a minimally invasive surgery (through a few small incisions). da Vinci® Surgery is a type of minimally invasive surgery.
Why da Vinci Surgery?
The da Vinci System features a magnified 3D HD vision system and special instruments that bend and rotate far greater than the human hand. These features enable surgeons to operate with enhanced vision, precision, and control.
da Vinci Prostatectomy offers the following potential benefits compared to open surgery:
- Similar positive surgical margin rates* 1,2,3,4
- Faster return of erectile (sexual) function 5,6
- Better chance for return of urinary continence within 6 months 4,5,6
- Less blood loss 1,4,5,6,7 or need for transfusion 1,4,6,7
- Lower risk of complications 4,7
- Lower risk of wound infection 1,7
- Shorter hospital stay 1,4,5,8
- Less chance of hospital readmission 9,10
- Fewer days with catheter 5,11
- Less risk of deep vein thrombosis** 1,12
da Vinci Prostatectomy offers the following potential benefits compared to traditional laparoscopy:
- More patients return to pre-surgery erectile function at 12-month checkup 13,14
- Faster return of urinary continence 14,15
- Lower risk of complications 1,16
- Better nerve sparing rate 17,18
- Shorter hospital stay 1,19
Over the past 20 years, the da Vinci System has brought minimally invasive surgery to more than 3 million patients worldwide. da Vinci technology – changing the experience of surgery for people around the world.
Risks & Considerations Related to Radical Prostatectomy (removal of prostate gland and some surrounding tissue): leaking of urine, urgent need to urinate, cannot get or keep an erection, rectal or bowel injury, narrowing of the urethra, pooling of lymph fluid in the pelvic area or legs.
* Surgical margin: Surrounding tissue that is removed with the tumor. If cancer cells are found in this tissue, it’s called a “positive surgical margin”. If cancer cells are not found, it’s called a “negative” or “clear margin”.
** Deep vein thrombosis: Dangerous condition that occurs when a blood clot forms deep in the body.
1. Tewari A. et al., Positive surgical margin and perioperative complication rates of primary surgical treatments for prostate cancer: a systematic review and meta-analysis comparing retropubic, laparoscopic, and robotic prostatectomy. Eur Urol. 2012 Jul;62(1):1-15. Epub 2012 Feb 24
2. Weerakoon M. et al., Predictors of positive surgical margins at open and robot-assisted laparoscopic radical prostatectomy: a single surgeon series. J Robotic Surg. 2011. http://dx.doi.org/10.1007/s11701-011-0313-4
3. Coronato E.E. et al., A multiinstitutional comparison of radical retropubic prostatectomy, radical perineal prostatectomy, and robot-assisted laparoscopic prostatectomy for treatment of localized prostate cancer. J Robotic Surg (2009) 3:175-178. DOI: 10.1007/s11701-009-0158-2.
4. Health Information and Quality Authority (HIQA), reporting to the Minister of Health-Ireland. Health technology assessment of robot-assisted surgery in selected surgical procedures, 21 September 2011. http://www.hiqa.ie/system/files/HTA-robot-assisted-surgery.pdf
5. Rocco B. et al., Robotic vs open prostatectomy in a laparoscopically naive centre: a matchedpair analysis. BJU Int. 2009 Oct;104(7):991-5. Epub 2009 May 5.
6. Ficarra V. et al., A prospective, non-randomized trial comparing robot-assisted laparoscopic and retropubic radical prostatectomy in one European institution. BJU Int. 2009 Aug;104(4):534-9.
7. Carlsson S. et al., Surgery-related complications in 1253 robot- assisted and 485 open retropubic radical prostatectomies at the Karolinska University Hospital, Sweden. Urology. 2010 May;75(5):1092-7
8. Lott F. et al., Is previous experience in laparoscopic necessary to perform robotic radical prostatectomy? A comparative study with robotic and the classic open procedure in patients with prostate cancer. Acta Cirurgica Brasileira. 2015;30(3):229-234. doi:10.1590/s0102- 8650201500300000011.
9. Fabbro E. et al., Robot-assisted laparoscopic prostatectomy: an economic analysis for decision- making in a university hospital of Northern Italy. Epidemiology Biostatistics and Public Health - 2015, Volume 12, Number 1.
10. Pilecki M.A. et al., National Multi-Institutional Comparison of 30-Day Postoperative Complication and Readmission Rates Between Open Retropubic Radical Prostatectomy and Robot-Assisted Laparoscopic Prostatectomy Using NSQIP. 2013, DOI: 10.1089/end.2013.0656
11. Ryu J. et al., Retropubic Versus Robot-Assisted Laparoscopic Prostatectomy for Prostate Cancer: A Comparative Study of Postoperative Complications. 2013, Korean J Urol 2013;54:756-761.
12. Davis J.W. et al., Learning Curve Assessment of Robot-Assisted Radical Prostatectomy Compared with Open-Surgery Controls from the Premier Perspective Database. 2013, DOI: 10.1089/end.2013.0534.
13. Asimakopoulos A.D. et al., Randomized comparison between laparoscopic and robot-assisted nerve-sparing radical prostatectomy. J Sex Med. 2011 May;8(5):1503-12. doi: 10.1111/j.1743-6109.2011.02215.x. Epub 2011 Feb 16.
14. Porpiglia F. et al.,Randomised Controlled Trial Comparing Laparoscopic and Robot-assisted Radical Prostatectomy. Eur Urol. 2012 Jul 20. [Epub ahead of print]
15. Moran P. et al., Robot-assisted radical prostatectomy compared with open and laparoscopic approaches: A systematic review and meta-analysis. International Journal of Urology. 2013;20(3):312-321. doi:10.1111/ iju.12070.
16. Sugihara T. et al., Robot-assisted versus other types of radical prostatectomy: Population-based safety and cost comparison in Japan, 2012–2013. Cancer Sci (2014) doi: 10.1111/cas.12523
17. Wagenhoffer R. et al., Switching from Endoscopic Extraperitoneal Radical Prostatectomy to Robot-Assisted Laparoscopic Prostatectomy: Comparing Outcomes and Complications. 2015, Urol Int DOI: 10.1159/000376587.
18. Park J.W. et al. Comparative Assessment of a Single Surgeon’s Series of Laparoscopic Radical Prostat ctomy: Conventional Versus Robot-Assisted. 2011, Journal of Endourology. DOI: 10.1089=end.2010.0229.
19. Ho C. et al., Robot- Assisted Surgery Compared with Open Surgery and Laparoscopic Surgery: Clinical Effectiveness and Economic Analyses [Internet]. Ottawa: Canadian Agency for Drugs and Technologies in Health (CADTH); 2011 (Technology report no. 137).