June 27, 2022
Dr. Hemang Bakshi, Head of Department of Urooncology and Robotic Surgery, HCG Cancer Centre, Ahmedabad
The fact that robotic technology has made cancer surgeries more tolerable, effective and safe is beyond any shadow of a doubt. By offering a clear and magnified view of the surgical site, robotic surgeries allow surgeons to operate on the tumour with enhanced accuracy and flexibility. Robotic surgery is one of the highly-promising treatment options for early-stage prostate cancers.
Lately, robotic prostatectomy is becoming a standard treatment option for prostate cancers that have not spread outside the prostate gland (localised). Robotic prostatectomy is associated with reduced pain and blood loss, minimal tissue damage, reduced scarring, shorter hospital stays and faster recovery. Most importantly, the risk of infections is also significantly lower in cancer patients who have undergone a robotic prostatectomy.
Robotic technology allows surgeons to perform prostatectomy with millimetre precision. This precision, along with better visibility, helps the surgeon in carefully identifying, exposing and removing the cancerous tissue. The seven degree-freedom provided by the jointed robotic instruments improves dexterity, allowing the surgeon to seamlessly perform more complex and technically-demanding surgeries, like prostatectomy. This enhanced precision translates to multiple benefits like fewer treatment-related complications, shorter hospital stays and quicker recovery.
Reduced Tissue Damage
The prostate gland is deeply located inside the pelvis. This gland is surrounded by vital structures like the venous complex, rectum, sphincter muscles responsible for urinary control and nerves responsible for sexual functions.
During traditional prostatectomy, it is challenging to differentiate the adjacent muscles, blood vessels and veins that closely surround the prostate gland. If these structures are damaged during the surgery, the patient may suffer from urinary incontinence or erectile dysfunction. Also, the anastomosis between the bladder and urethra is difficult to perform.
However, during robotic prostatectomy, the surgeon has better control over the procedure, and the surgery is performed in such a way that the damage to the surrounding normal tissue is significantly reduced.
Reduced Blood Loss, Pain and Scarring
The robotic surgical system allows the surgeon to perform more precise and less-disruptive dissection, which helps in reducing blood loss. The use of gas, which is inflated into the abdomen during surgery to create pressure and help provide surgeons with a better view, also minimises blood loss.
Since tiny incisions are made instead of one large incision, robotic prostatectomy also benefits patients with significantly lesser pain and scarring.
In most cases of radical prostatectomy, the hospital stay does not last more than 1-2 days, regardless of age. This quick recovery is aided by smaller incisions and substantially less blood loss. The patients also experience reduced postoperative pain, and the need for pain medication is reduced too.
We have multiple reports on robotic prostatectomy having a strong track record in terms of continence too. Following surgery, some men experience instant bladder control. Most men, on the other hand, require weeks or months to regain full control of their bladder.
Also, patients do not find much difficulty in gradually regaining their sexual functions after robotic prostatectomy. During robotic prostatectomy, surgeons may use nerve-sparing procedures to reduce the risk of impaired sexual functions.
Robotic surgeries offer the much-needed precision and control that a surgeon will require while performing a prostatectomy for localised prostate cancers. In western countries, about 90% of radical prostatectomies are performed through robotic surgery. Even in India, the numbers are picking, and more and more cases of prostatectomy are being performed via robotic surgeries lately. By benefitting the patient in terms of fewer treatment-related complications and faster recovery, robotic prostatectomy has changed the way early-stage prostate cancers are treated.
– By Dr. Hemang Bakshi, Head of Department of Urooncology and Robotic Surgery, HCG Cancer Centre, Ahmedabad.