Jihad Kaouk, MD, who performs robotic and laparoscopic prostate surgery at the Cleveland Clinic Glickman Urological and Kidney Institute, answers commonly asked questions about the technology and its use in prostate cancer surgery.
What is a radical prostatectomy?
A surgical treatment for prostate cancer, the radical prostatectomy procedure removes the entire prostate gland. Radical prostatectomy can now be done by laparoscopic or robotic techniques.In open prostate surgery, the prostate gland is removed through a larger incision in the lower abdomen. Laparoscopic prostate surgery involves key-hole incisions which used for inserting a lighted viewing instrument (laparoscope) into the pelvic region and allows examination and removal of the prostate without a large abdominal incision.
What are laparoscopic and robotic surgery?
Laparoscopic and robotic prostate surgery are minimally invasive techniques for performing surgery. Both these procedures allow surgeons to operate through small ports rather than large incisions, resulting in shorter recovery times, fewer complications and reduced hospital stays. Surgical robotics combines minimally invasive surgery with advanced robotic technology.
What is a robotic or laparoscopic radical prostatectomy?
Now routine procedures at Cleveland Clinic, laparoscopic or robotic prostatectomy are minimally invasive surgery procedures used to remove the prostate. Both forms of surgery are now routinely offered at the Cleveland Clinic to patients with prostate cancer. Our single-institution experience now exceeds 1000 cases of laparoscopic and robotic prostate surgery performed.
When is this procedure used?
Laparoscopic and robotic prostatectomy are used to treat patients who have prostate cancer. We offer these procedures to all patients who are candidates for open radical prostatectomy.
What does this procedure involve?
Unlike traditional open surgery, laparoscopic and robotic surgery require only four to five small, button-hole incisions, through these incisions, a surgeon uses a powerful, high-precision endoscope - a tiny camera - and specialized surgical instruments to remove the prostate.
What is the difference between robotic and laparoscopic radical prostatectomy?
Both are minimally-invasive techniques of performing radical prostatectomy for cancer. In laparoscopic radical prostatectomy, the surgeon stands by the operating table and himself manipulates the instruments. In robotic prostatectomy the surgeon is seated at a robotic console near the patient from where he drive the robotic instruments to perform the operation. The robot faithfully and accurately reproduces the surgeon's sophisticated maneuvers.
How does robotic-assisted surgery work?
The computer-enhanced robotic surgical system consists of three components that provide:
- A 3-D view of the surgical field, including depth of field, magnification and high resolution
- Instruments that are designed to mimic the movement of the human hands, wrists and fingers, allowing an extensive range of motion and more precision
- Master controls that allow the surgeon to manipulate the instruments, translating the surgeon's natural hand and wrist movements into corresponding, precise and scaled movements. Robotic arms remain steady at all times and robotic wrists make it easier for surgeons to precisely manipulate tissue and work on the prostate from all kinds of angles.
How long does this robotic surgery take?
Although robotic prostate surgery takes approximately 2-4 hours to perform, patients generally feel much better and have significantly fewer pain requirements in the early post-operative period.
What are the advantages of this procedure?
This procedure is performed through small key-hole incisions that do not cut muscle. Laparoscopic and robotic prostatectomy offer surgeons unparalleled visualization of the area, thus permitting precise removal of the prostate. Patients also experience significantly less blood loss. Additionally, patients benefit from:
- Reduced hospital stay after surgery (1-2 days average) and faster healing
- Less postoperative pain and virtually no need for pain medication
- Earlier removal of catheter (1 week typically)
- Shorter recovery time
- Quicker return to normal activity (one to two weeks) and work (two to three weeks)
- Smaller "Band-aid" incisions and less scarring
How long has Cleveland Clinic been performing laparoscopic prostatectomies?
Cleveland Clinic was the first in the United States to establish laparoscopic prostatectomy program in 1997 and routinely offer this procedure to patients. Our specialists have been performing robotic prostate surgery for the past 5-6 years.
Robotic and Laparoscopic Surgery Offer Advantages in Treatment of Prostate Cancer
Cleveland Clinic was the nation's first medical center to routinely perform laparoscopic prostate surgery and amongst the first to perform robotic radical prostatectomy. Now laparoscopic and robotic surgery is enabling surgeons to perform this complex minimally invasive surgery with more precision, offering patients improved outcomes. Cleveland Clinic uses the state-of-the-art robotic surgical system that has been approved by the FDA for use in performing many surgical procedures, including radical prostatectomies, general laparoscopic surgery, thoracoscopic (chest) surgery, and thoracoscopically-assisted heart procedures.
What are the benefits to patients who have laparoscopic and robotic prostate cancer surgery?
The benefits are similar between robotic and laparoscopic prostate surgery. Patients are usually able to go home the day after prostate surgery, and can return to daily living activities as early as 7-10 days after surgery. Patients undergoing open surgery generally have 4-6 weeks before they can resume routine daily living activities, generally experience less post-operative pain and discomfort and have a faster recovery. They also experience significantly less intraoperative bleeding. Robotic and laparoscopic prostatectomy uses small incisions and is highly precise; the risk of incontinence is low; and the surgical technique is continuously refined to improve potency.
What sexual side effects are possible after robotic and laparoscopic prostate surgery?
Laparoscopic and robotic prostate surgery are highly precise in their ability to spare the nerve bundle responsible for erections.The degree of sexual function after radical prostatectomy is determined by many factors. These include the man's age, how sexually active he was before the procedure. Most men experience at least temporary erectile problems after a radical prostatectomy. Our recently demonstrated 82% potency rate at 1 year following "energy-free" laparoscopic radical prostatectomy in patients with excellent preoperative erections is amongst the best in the literature. (in press- video)
After Surgery Information
- Robotic prostate surgery operative time is typically 2-4 hours
- Hospital stay is typically 1-2 days
- Our team will be seeing you on a daily basis during your stay in the hospital and will give you detailed after-surgery instructions prior to your discharge home.
- Foley Catheter (urine catheter) typically comes out on day 5 after a cystogram (special xray study to check the bladder)
- Jackson Pratt drain comes out around the time of Foley catheter removal depending on your individual circumstances
- No driving for 7 days after prostate surgery
- No other restrictions in physically activities after surgery - just do what you can tolerate
- Aspirin can be restarted when you are back to eating regular meals
- You will be given Viagra upon the removal of the foley catheter. Typically 50mg a night, increasing to 100mg if no response. This is not given to necessarily induce erections, but to help improve the blood supply to your penis. If you have any heart conditions, your internal medicine doctor needs to clear you before taking Viagra.
- The first PSA check after prostate surgery is at 1 month and then 3-6 months thereafter.
We would be happy to see you for post-operative follow-up, but if you desire to have your follow-up done locally we support that as long as you send in all your PSA, continence and erectile function data to Kay Lawson. Fax: 216.444.4830.
Who should I call if I have a problem after prostate surgery?
For urgent problems in the evenings or overnight, feel free to call the Cleveland Clinic Operator at 216.444.2200 and ask to speak to the On-Call Urology physician.
During the day or for non-emergent issues, feel free to call our office at:
800.223.2273, ext. 4-2976 or 4-2977 or
Locally please call: 216.444.2976 or 216.444.9375
Fax Number: 216.444.9375