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Indications of Da Vinci Robot Assisted Laparoscopic Prostatectomy

With 71.000 cases and 9.000 deaths diagnosed annually in France, Prostate cancer is the most frequent and deadly men cancer after lung.The Prostate cancer usually affects men in the second half of their life and is known for its slow evolution. When diagnosed early, prostate cancer is curable with a very high success rate. Robot-assisted radical prostatectomy (removal of prostate) is becoming the gold standard for treating prostate cancer and giving the patient best chances of recovery. Da Vinci robot is synonym of minimally invasive and precise surgery. Its usage has gradually grown since 2003.

 

Prostatectomy Indications

Prostatectomy is one of the curative treatments for prostate cancer in men.

Non-surgical curative alternatives include:

  1. Active surveillance is preferred when deemed indolent tumor delays implementation of most active treatments.
  2. Primary hormonal therapy
  3. Interstitial prostate brachytherapy
  4. Focused ultrasound (HIFU)
  5. Cryotherapy

The curative treatment of prostate cancer is also advised in case of localized forms (intra capsular).

It can also be considered on a case by case basis with limited extrusion of cancerous cells outside prostatic capsule.

It is contraindicated in cases of metastatic spread to lymph nodes or other surrounding organs, such as for example the bony skeleton.

Once the curative approach is decided, prostatectomy surgery is offered to men whose life expectancy exceeds 10 years. Most suitable patients are those between ages 50-70, while patients older than 75 years won’t be concerned.

 

Indications of Robot Assisted Laparoscopic Prostatectomy with Da Vinci (RALP)

Excision concerns – as with conventional opened surgery or conventional laparoscopy – the entire prostate and seminal vesicles.

Robotic laparoscopy begins with a few mini incisions (roughly the size of a key hole & similar to traditional laparoscopy) in opposition to open  procedure where the lower abdomen is opened with a large incision.

These mini incisions allow insertion of trocars secured to the robot arm through which surgical instruments will be activated.

The fineness, maneuverability and accuracy of surgical instruments are particularly useful to protect the thin erectile nerves beams located around the prostate (unless cancer cells are too close) and the urethral sphincter impacting continence.

 

Incision trocarts Prostatectomy

The Da Vinci robot, approved in 2001 by the FDA (Food and drugs administration), provides ultra precise response and the use of its remote handling with 3D vision recreates the conditions of a classic intervention but managed from a console.

Radical prostatectomy is the surgery that makes the most of robotic surgery advantages, especially using the Da Vinci system.

RALP is indicated with all patients for whom prostatectomy is practicable and chosen as treatment.

 

Robot-assisted Laparoscopic prostatectomy main advantages:

  1. Impact on sexuality: thanks to the vision of prostate region provided by Da Vinci robot and thanks to the manoeuvrability and sharpness of its instruments, accuracy of the dissection is optimized to preserve a maximum of arterial and venous vascular structures involved in erection process. This outcomes into a significant increase in percentage of patients recovering erection capabilities.
  2. Impact on urinary function: for the same reasons, Da Vinci robot enables a more precise dissection preserving the sphincter (neighboring prostate). The precision and sealing sutures of the bladder on the urethra lead to faster recovery of urinary continence: nearly 98% of patients after one year, versus only ~80% for traditional laparoscopy.
  3. Minimise scarring as well as infection and/or bleeding risks. Da Vinci surgeries induce 10 times lower Blood losses.
  4. Reduce post operative pain.
  5. Shorten hospital stays significantly ..
  6. Allow faster return to active life.

These advantages are made possible thanks to unique abilities conferred by Da Vinci system to Urologist surgeon such as:

  • An excellent vision of operation field,
  • A large operating ease
  • A remarkable precision of gestures,
  • And two exclusive assets : its tremor reduction feature & ability to slowdown gestures to enhance surgeon’ dexterity to unknown levels.

Note: The description of Da Vinci robot and features is detailed thru this other article.

 

Deploying the Da Vinci robot

Prostatectomy da vinciSurgical Teams who adopted Da Vinci robot systematically use it in preference to traditional laparoscopy (in the US in more than 80% of prostate cancer operations).

The number of Da Vinci robot installations has experienced a significant growth in recent years. End of 2013, 80 robots were in operation in France & 3.000 units in the world. In France, several training centers teach urologist surgeons how to use the da Vinci robotic system.

 

 

However it has to be kept in mind that urologist quality and experience remain the key elements for intervention success . It is also important to note that risks pertaining to each procedure and each patient remain and won’t be annihilated by use of Da Vinci robot.

The arrival of Da Vinci robot represents a new stage in the surgery evolution, without condemning traditional procedures that keep providing decent results.

 

Dr. DAVODY speaks in his own name and receives no sponsorship from the INTUITIVE SURGICAL company.

 

Some bibliographic elements:

http://www.e-cancer.fr/cancerinfo/les-cancers/cancers-de-la-prostate/la-prostatectomie-totale

http://www.davincisurgery.com/fr/da-vinci-urologie/pathologies/cancer-de-la-prostate/

Vidéo: https://www.canal-.tv/video/canal_u_medecine/prostatectomie_radicale_par_voie_laparoscopique_extraperitoneale.1965

Indications of prostatectomy

http://urofrance.org/science-et-recherche/base-bibliographique/article/html/la-prostatectomie-totale-robot-assistee-complications-perioperatoires-resultats-anatomopatho.html

http://www.davincisurgery.com/fr/da-vinci-urologie/traitement/chirurgie-ouverte/prostatectomie.php

http://fom-k.net/sites/fom-k.net/files/u3/c_iselin.pdf

http://www.chrcitadelle.be/servlet/Repository/chirurgie-laparoscopique-robot-assistee.pdf?ID=2299

http://www.hpsj.fr/wp-content/uploads/2015/01/Prostatectomie_radicale_ROBOT2.pdf

Generalization of robot-assisted prostatectomy

http://www.chrcitadelle.be/fr/patients/services-medicaux/urologie/chirurgie-par-laparoscopie-avec-le-robot-da-vinci.html