Robotic-Assisted Laparoscopic Radical Prostatectomy:
Also known as daVinci Prostatectomy or Robotic Prostatectomy. Dr. Kaynan has observed, assisted, performed and taught hundreds of these operations. This method, considered minimally invasive, incorporates a state-of-the-art computerized surgical system that facilitates the performance of laparoscopic surgery. It provides a magnified and brighter image than standard laparoscopic telescopes, and unlike the 2-dimensional image seen with standard laparoscopy, the daVinci system is stereoscopic (3-dimensional). The instruments have Endowrist technology which provide for multiple degrees of freedom of motion, much like a normal wrist and elbow, but with greater range of motion than what the human hand is capable of. The robot has a motion-scaling feature which eliminates hand tremor entirely and gives the operating surgeon greater finesse than what is natural. The standard use of gas under pressure to create the working space in the abdomen has made this procedure virtually bloodless. These features have collectively made it much easier to perform radical prostate surgery laparoscopically. As a result, we have realized the best outcomes all around, and robotic prostatectomy is now standard of care for the treatment of prostate cancer:
- Reduced margin positive rates (ie, better chances for cancer cure)
- The worst complications have been reduced in frequency to virtually case reports (including death, heart attack, stroke, and blood clots)
- Least blood loss (typically less than 150cc) – blood transfusions are now extremely rare
- Shortest hospital stay (95% of patients are discharged after only one night in the hospital)
- Least pain
- Least chance of infection
- Shortest catheter time (1 week instead of 2)
- Least chance of internal scars impeding the flow of urine (less than 5% instead of 10%)
- Fastest return to activities of daily living (driving a car in 1 week instead of 4-6)
- Fastest return of urinary control (median 3 months instead of 6)
- Fastest return of erectile function (median 6 months instead of 1 year)
Summary of daVinci Robotic Prostatectomy for the treatment of prostate cancer*:
- The majority of Dr. Kaynan’s daVinci Prostatectomy patients are discharged from the hospital one day after surgery.
- Blood loss and scarring are reduced to an insignificant minimum.
- Robotic prostatectomy patients recover faster compared to open prostatectomy.
- Video magnification, Endowrist instrumentation, and gas insufflation better allow for achievement of the prostate cancer “trifecta”: eradication of cancer, preservation of urinary control, and preservation of sexual potency.
- daVinci Prostatectomy is standard of care for patients with prostate cancer and is the most popular approach by far in the United States and Europe. Virtually all patients who are candidates for surgery are candidates for a daVinci Prostatectomy.
| Open Surgery | Robotic Surgery | |
|---|---|---|
| Hospital Stay | 85% 1 day | 95% 1 day |
| Estimated Blood Loss | 600 cc | <150 cc |
| Postop Pain (0-10) | 7 | 3 |
| Catheter Time | 2 weeks | 1 week |
| Return to Driving | 4-6 weeks | 1 week |
| Cancer Margins** | 11% | 6% |
| Time to Urinary Control | 6 months | 3 month |
| Time to Erections | 1 year | 6 months |
*The benefits of daVinci Robotic Prostatectomy cannot be guaranteed as surgery is both patient and procedure specific.
** Pathologic T2, Gleason’s 6 tumors; lower margin rates portend better chances of cancer cure.
