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Questions and Answers From Dr. Boczko about Robotic Surgery
What is prostate cancer?
Dr. Boczko: Prostate cancer is a disease in which malignant (cancer) cells form in the tissues of the prostate. Prostate cancer is the #1 newly diagnosed noncutaneous malignancy in men. In 2006, approximately 234,460 will be diagnosed with prostate cancer and 27,350 men are expected to die as a result of the disease.
Dr. Boczko: The prostate gland produces fluid that makes up part of the semen. The prostate is a gland in the male reproductive system located just below the bladder and in front of the rectum. It is about the size of a walnut and surrounds part of the urethra (the tube that empties urine from the bladder). Prostate cancer is found mainly in older men but I have seen it diagnosed even in men in their late 30s. Prostate cancer produces no classic symptoms. This is one reason we screen patients with rectal exams and PSAs. Typically, as men age, the prostate may get bigger and block the urethra or bladder. This may cause difficulty in urination or can interfere with sexual function. This condition is called benign prostatic hyperplasia (BPH), and although it is not cancer, surgery may be needed to correct it. The symptoms of benign prostatic hyperplasia or of other problems in the prostate may be similar to symptoms of prostate cancer.
Anatomy of the male reproductive and urinary systems, showing the prostate, testicles, bladder, and other organs.
Dr. Boczko: A person’s prognosis is based on several factors including the following:
Dr. Boczko: Treatment options need to be tailored to the individual. Options include the following:
Dr. Boczko: This is an operation that is also called, da Vinci Prostatectomy. It is a minimally invasive procedure that utilizes the da Vinci robot and the latest technology in computer software to aid in the removal of the prostate. The da Vinci® Surgical System is a robotic surgical system consisting of three main components: a)The InSite® Vision System which provides the surgeon with a true minimally invasive 3-D view of the surgical field. b)The Surgical Cart that includes the EndoWrist® Instruments. The EndoWrist Instruments are designed to mimic the movement of the human hands, wrists and fingers. c) The Surgeon Console which contains the master controls that the surgeon uses to manipulate the EndoWrist Instruments.
Dr. Boczko: No. It has actually been around since 2003. The technique, as with any surgical procedure, continues to be refined. What a patient must know is that experience counts. There is a definite learning curve for a urologist in this operation and it pays for a patient to find out how well trained their urologist is.
Dr. Boczko: Currently, published cancer cure rates after robotic prostatectomy is equivalent to that of open surgery. In the future, we hope to actually see better cure rates due to the robot's technological advantage. This would be an additional benefit to the minimally invasive and decreased side effect benefits we already see from utilizing the robot.
Dr. Boczko: With its 3-D view and its 10x optical magnification, the da Vinci® Surgical System aids the surgeon in more easily identifying vital anatomy such as the delicate nerves surrounding the prostate and the prostate edges themselves. This is especially important in sparing the neurovascular bundles responsible for erectile function, performing a water-tight vesico-urethral anastomosis, and lowering the positive margin cancer rates. The EndoWrist® Instruments provide the surgeon with dexterity not available using conventional laparoscopic instruments to perform a delicate and precise surgical dissection and reconstruction of the bladder and urethra. Summary of benefits:
Dr. Boczko: Most men with localized prostate cancer are candidates for robotic prostatectomy. I have been asked in the past if a large prostate or an obese patient excludes a person from undergoing the operation. I recently presented data that showed age, large prostates, obesity, and prior hernia or intra-abdominal surgery are not contraindications for robotic prostatectomy. However, not everyone is a candidate and a urologist must make that determination with the patient.
Dr. Boczko: Once the initial incision is made, the operation usually lasts between 2.5 to 3 hours. It can vary depending on a person’s internal anatomy and body habitus.
Dr. Boczko: No. It is rare but can occur. The low blood loss that occurs during the operation is one of the benefits of a robotic prostatectomy.
Dr. Boczko: The normal hospital stay lasts 24 hours. What I tell patients to expect is the following: The night after the operation - patient should be able to drink clear liquids and hopefully be at least out of bed into a chair. The morning after the operation - patient should be able to walk around, tolerate regular food, and be on oral pain medications(if needed). The afternoon/evening - patient typically goes home. Approximately 90% of my patients go home at that time. Not every case goes exactly as planned and certain medical conditions a patient might have before the operation might cause a patient's length of stay to be slightly longer for precautionary reasons.
Dr. Boczko: Every person is different and only you will know what you are capable of. In general, I tell people they should attempt to go back to performing basic daily activities as soon as they can. Staying in bed is not advised if a patient is able to walk around. The patient will have a Foley catheter after leaving the hospital and this could be a source of irritation and discomfort. For that reason, I advise my patients to not drive on their own. It is more of a safety factor. If they are driving and need to stop short due to a car or disturbance in front of them, they might not be as quick to the brake pedal as they normally would. Once the Foley comes out, they should be able to go back to driving. As far as activities, I encourage walks but no running, jumping, or anything that causes bearing down in the pelvic region. I also tell my working patients to take the time off during this period.
Dr. Boczko: The catheter is usually removed in the first postoperative visit 7-10 days after the operation.
Dr. Boczko: The nerves that help control erections are just underneath and to the sides of the prostate. Every effort is made to spare these nerves during the operation. One advantage of using the robot is the optical magnification of these nerves and the ability to more precisely dissect the prostate off of them without injury. However, not every person can have a full nerve sparing procedure. If a person has high-grade cancer in the area of the nerves, it is not advised that nerve preservation in the area occurs. Our number one goal is cancer eradication and cure. Even after nerve preservation, return of potency is not a guarantee and can take 6 to 12 months to return.
Dr. Boczko: After the catheter is removed, every man will experience some sort of urinary leakage that will require a urinary protective pad. The worst of it is usually in the first couple of weeks after the operation. The return of continence (control of urination) is fast with this operation and over 95% of patients should expect to regain full control of their urination. We encourage the patient to perform Kegel exercises to help them in their recovery. These exercises involve the muscles that help stop urinary flow and are explained to the patient after the Foley is removed. If a patient desires, he may practice these exercises even before the operation takes place so that he may be ready to perform them once the Foley catheter is removed.
Dr. Boczko: No weight-bearing activity of greater than 15 pounds should be done until 6 weeks after the operation. This includes golfing (not putting though), running, gym exercises, construction work and the like. Walking and non weight-bearing activity is encouraged and a patient should be able to go back to work within 2-5 weeks if it does not involve any of the restricted activities.
Center for Robotics, Laparoscopy, and Advanced Urology
WESTMED Medical Group
210 Westchester Avenue
Department of Urology
White Plains, NY 10604
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