Since 2001, Cleveland Clinic has been using the state-of-the-art robotic surgical system approved by the FDA for many surgical procedures. Cleveland Clinic was one of the nation's first medical centers to offer minimally invasive surgical treatment for prostate cancer: robotic radical prostatectomy. Now, robotic-assisted surgery is enabling surgeons to perform this complex minimally invasive surgery with more precision, offering patients improved outcomes. We have performed over 1,000 robotic and laparoscopic prostatectomy procedures to date and continue to be the leaders in the prostatectomy field.
Our underlying principle is to provide care with a degree of unparalleled dedication and excellence. The Glickman Urological and Kidney Institute was ranked #2 in the nation by U.S. News & World Report in its 2013-2014 "America's Best Hospitals" survey.
In addition, Cleveland Clinic was named one of the nation's top 4 hospitals in that survey.
What is Robotic-Assisted surgery?
Robotic-assisted surgery, a type of minimally invasive surgery (MIS), uses surgical robotic equipment, which imitates surgical movements. MIS 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 techniques with highly advanced clinical technology.
How does Robotic-Assisted Surgery work?
The computer-enhanced minimally invasive surgical system consists of three components that provide:
- A 3-D view of the surgical field, including depth of field, magnification and high resolution
- Robotic 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 robotic movements
Live Video of Robot in Action!
Dr. J. Kaouk demonstrates how he manipulates the robotic hand controls to move the robot.
How does the new robotic technology assist the surgeon?
The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss. Because of robotic technology, surgeons are able to perform minimally invasive procedures with more precision. Robotic arms remain steady at all times and robotic wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles - positions surgeons would have difficulty reaching otherwise.
Am I a candidate for Robotic Prostate Surgery?
Majority of people with prostate cancer are candidates for robotic surgery, however you and your surgeon will be able to determine what course of prostate treatment is right for you.
How far in advance should I book my surgery?
We require at least two weeks for scheduling purposes.
How is the prostate removed?
The prostate gland is removed through a small incision in the abdomen.
Will I need to prepare blood before robotic prostate surgery?
No, robotic surgery is minimally invasive, and therefore affords minimal blood loss. Our data show that risk of blood transfusion after surgery is less than 1%.
Is nerve-sparing possible?
Yes, robotic surgery provides 3D vision and precise direction that allow for nerve sparing. In cases where wide excision of the prostate and nerve is planned prior to surgery and discussed with the patient, then a sural graft of the nerve is an option.
Will I be incontinent after robotic prostate surgery?
In men, there are 3 main mechanisms to control urine. The bladder neck is cut during surgery to remove the prostate. The prostate itself, which helps continence, is removed. The remaining mechanism left intact to hold urine is the external sphincter. After surgery, patients leak urine, but Kegel's exercises are taught to strengthen the appropriate muscles and gain urine control. We have data that shows 96-98% of patients are continent (have good bladder control) after surgery.
What are the sexual side effects after surgery?
The degree of sexual function after a radical prostatectomy is determined by many factors. These include the patient's age, how sexually active he was before the procedure, how much the surgical procedure affects the nerves and how sexually motivated he is after surgery. Most men experience at least temporary erectile problems after a radical prostatectomy.
Will I be able to follow up with my local physician?
Yes, you will be able to follow up with your family doctor following robotic surgery.
What follow-up is needed?
In most cases, a Prostate Specific Antigen (PSA) test is required every 3-6 months.
Will I be able to drive home?
No, you should not drive for at least 7 days following surgery. However, you will be able to ride in the passenger seat of a vehicle.
Will I be able to fly on an airplane after surgery?
Yes, you will be able to fly, but only with a companion on the plane with you.
When can I exercise after robotic prostate surgery?
Walking will be permitted right after surgery. Heavier exercise should be postponed for 3-4 weeks.
As is the case with other minimally invasive procedures, robotic surgery has potential advantages over traditional open surgery:
- Length of hospitalization is often shortened to one or two days.
- The three-dimensional vision system magnifies the surgical field up to 15 times and improves the ability of the surgeon to recognize and control small blood vessels, thereby reducing blood loss.
- There is often no need to prescribe narcotic analgesics on discharge. Patients generally need nothing more than Tylenol.
- Approximately 90% of patients can return to work or resume full activity in only two to three weeks.
- For prostatectomy, complete continence (no leakage at all) is obtained in 94% of patients within 6 months.
- Surgeons are able to perform minimally invasive procedures with more precision. Robot arms remain steady at all times and robot wrists make it easier for surgeons to manipulate tissue and work from all kinds of angles - positions surgeons would have difficulty reaching otherwise. In this way full functionality of the prostate can be preserved in the vast majority of cases.