At the Prostate Cancer Institute of LA, we pride ourselves on providing our patients with the best and most effective prostate cancer treatment in Los Angeles. The daVinci Robotic Prostatectomy is an advanced robotic prostatectomy whole gland treatment. To learn more about this exciting and innovative new surgical tool, please contact our facilities today.
What is Prostate Cancer Robotic Surgery?
The daVinci Robotic Prostatectomy is the most advanced surgical means of treating prostate cancer. Robotic surgery in expert hands has excellent outcomes. The robotic surgeons at the Prostate Cancer Institute of LA are leading robotic prostate cancer surgeons with over 1,000 surgeries provided to date. The daVinci robotic surgery is one of the many state of the art technologies used at the Prostate Cancer Institute of LA to provide minimally invasive custom tailored therapies for outpatients.
A daVinci robotic prostatectomy undoubtedly enhances the outcomes for our patients. Our surgeons are able to perform procedures that are custom-tailored operations because of the information they have from the perfusion dynamic MRI studies. Using the studies, our surgeons have more insight as to whether or not the cancer is involving the nerves responsible for directions. By having this information, our surgeons can judiciously determine an optimal surgical approach (nerve sparing versus non-nerve-sparing approaches).
All of these factors result in enhanced outcomes for patients, both in regards to cancer control as well as functional outcomes and quality of life. We are delighted to have been able to help so many patients with the daVinci robotic device for minimally invasive prostate cancer treatment and look forward to assisting others.
daVinci Robotic Prostatectomy Procedure
The daVinci robotic prostatectomy can be broken down into eleven steps.
Step 1. Patient setup
Our patients in Los Angeles are brought into the operating room where anesthesiologists and the rest of our team members greet them. Our patient then undergoes anesthesia and is positioned for the robotic prostatectomy procedure. Subsequently, six incisions measuring approximately 1 cm (half an inch) in size each are placed in the abdomen as illustrated below. Through each port a trocar is placed, which allows instruments to be placed into and removed from the abdominal cavity. This is how laparoscopic and robotic operations are performed. The fact that smaller incisions are necessary for the procedure is only one of the many advantages of the robotic prostatectomy operation as compared to the standard open approach.
Step 2. Dissection of the seminal vesicles
The first step of robotic prostatectomy is the dissection of the seminal vesicles often the adjoining tissue to allow them to be removed with the prostate as a unit.
Step 3. Release of the bladder
The bladder is subsequently released from the connective tissue in the pelvis, allowing exposure to the endo-pelvic fascia and ultimately the prostate.
Step 4. Incision of the endo-pelvic fascia
By incising the endo-pelvic fascia, access is gained to the entire prostate and to the urethra.
Step 5. Control of dorsal venous complex
The dorsal venous complex is a large vein that runs on top of the prostate. Controlling it is one of the key steps to being able to free the prostate for removal. This step is elegantly performed with the use of a special surgical stapling device that staples and cuts the dorsal vein in one step. The result is outstanding with very little blood loss.
Step 6. Bladder neck dissection
The next step is freeing the prostate from the bladder. This is a critical step in the procedure. There are two urinary sphincters (round muscles that can squeeze down and keep the urine from leaking out of the urinary tract) in the male urinary tract. One sphincter is at the neck of the bladder as it joins the prostate, and the second is located around the urethra just below the prostate. Preservation of both of these sphincters aids in the recovery of urinary control in patients undergoing a robotic prostate surgery . Therefore, meticulous technique is used to preserve both the bladder neck sphincter as well as the urethral sphincter during the operation.
Step 7. Preservation of nerves for erections
In experienced hands, preservation of the nerves that control erections is relatively straightforward. The nerves sit just underneath the prostate and with meticulous dissection can be easily freed completely along the prostate. During this portion of the operation, great attention is paid to minimize any tension on the nerves. Electrocautery is also strictly avoided to ensure that no nerve damage occurs.
Step 8. Separating the prostate from the urethra
Once the prostate has been freed inferiorly from the rectum, superiorly from the bladder, and laterally from the nerves, then only the attachment to the urethra remains. By separating the prostate from the urethra, the prostate will now be completely freed and can be removed safely. During the separation of the prostate from the urethra, great care is given to preserve the urethral sphincter which is critical for preserving a man’s urinary control.
Step 9. Removal of the pelvic lymph nodes
During a robotic prostatectomy in Los Angeles, the pelvic lymph nodes that drain cancer cells from the prostate are removed for sampling. This information helps us determine if any evidence of microscopic disease has spread beyond the prostate. The lymph nodes are nestled superiorly by the iliac vein and artery and inferiorly by the obturator nerve. Meticulous technique is used to preserve all of these structures during the left node removal.
Step 10. Connecting the bladder neck to the urethra
After removal of the prostate, the bladder neck is sutured to the urethra. This is performed in such a fashion that the closure is watertight. The watertight anastomosis allows the urethral catheter to be removed earlier and ensures better healing of the bladder neck and urethral tissues.
Step 11. Removal of the prostate
After removing the prostate from the surrounding vital tissues, the prostate is placed into a specimen bag, which is retrieved at the end of the procedure. Removal of the prostate is performed by extending one of the incisions to a large enough caliber through which the prostate can be removed intact. All incision sites are subsequently closed and our patient is soon awakened from anesthesia and safely transferred to the recovery room.
Recovery from Robotic Surgery
After recovery from the anesthesia, our patients are transferred to a private room. The hospital stay for our patients in Los Angeles is typically one day and many of our patients are operated on as an outpatient (where they will go home in less than 24 hours). Within the first day of a robotic surgery for prostate cancer, our patients are able to, and are requested to, start walking. They are started on an oral diet within the first day of their operation as well. The typical recovery from a robotic prostate surgery for prostate cancer performed by the surgeons at Prostate Cancer Institute of LA is excellent. The majority of our patients go back to work within one to two weeks from the time of their operation.
Contact Urological Experts in LA Today!
To receive more information about your candidacy for a daVinci Robotic Prostatectomy, kindly contact the Prostate Cancer Institute of LA, a Division of Comprehensive Urology, today! Our highly-skilled daVinci robotic prostatectomy surgeons in Los Angeles will be glad to meet with you.
Next, read about TrueBeam therapy.