What is the success rate of open and robotic radical prostatectomy?

There are possible risks and side effects of any type of surgery for prostate cancer. In a special meta-analysis published in European Urology, incorporating 19 studies and 118,830 patients, comparing radical prostatectomy to radiotherapy, a clear advantage was seen for the surgery-treated patients.

Dr. Graefen and Dr. van der Poel have made an important session on the technical aspects of open and robotic radical prostatectomy. It has been discovered that primary treatment failure occurred in 3.2% and 10% of patients treated with surgery and radiotherapy, respectively. Even so, the European Association of Urology (EAU) guidelines clearly state that no definitive treatment modality has shown superiority over any other.

What is robotic radical prostatectomy?

It is a minimally invasive surgical removal of the prostate involving the latest advancements in robotics and computer technology. This procedure is also called da Vinci robotic prostatectomy.

Open surgery is considered successful when the cancer is removed even if it means the patient is left incontinent and/or impotent. Robotic surgery is considered successful when the cancer is cured, and the patient has full continence and potency. All 3 categories must be met to consider the surgery a success. This means quality of life is at its highest rate!

To improve the way this surgery is performed, both open and robotically, many tips and tricks were highlighted in this investigation. The first topic discussed was, of course, urinary continence. The impaired urinary control that most men experience after prostate surgery is very similar to the stress incontinence that women have after childbirth. Dr. David Samadi recommends Kegel exercises to every man after robotic prostate surgery. This simple exercise involves repetitive sets of clenching and releasing the muscles that stops the flow of urine. Research indicates that men who begin these exercises prior to surgery see improved recovery results afterward.

Also, patient selection is critical, and older patients that have a higher risk for urinary incontinence, for example patients with a short membranous urethra or those who have had a previous TURP (transurethral resection of the prostate is a surgery used to treat urinary problems due to an enlarged prostate) should be referred to another procedures such as focal therapy and radiotherapy, due to their increased risk of urinary incontinence.

Another important concept refers to the posterior reconstruction of the Denonvilliers’ musculofascial plate, often known as the “Rocco stitch”, which has received mixed reviews from practicing urologists on the effect of urinary continence rates.

Lastly, the resumption of sexual function after prostate surgery. It is important to avoid using energy or traction around the neurovascular bundles. To improve the nerve-sparing technique, the use of neurovascular structure-adjacent frozen section examination (Neurosafe) was recommended. With Dr. Samadi’s unique SMART Surgery, most patients are able to resume normal sex lives with complete erectile function in 12 to 24 months. Younger patients may experience faster or improved results.

As a conclusion, accurate anatomical dissection and reconstruction are critical to achieving maximal results. Dr. Samadi is dedicated to helping his patients through this process and will work with men and their partners to find the right solution for recovery after prostate cancer surgery.

There are several factors to consider in choosing your robotic prostate surgeon.

What you should know about the SMART technique!

• The most important thing to remember is that technology does not drive outcomes; the robot is only as skilled as the surgeon.
• During robotic prostate surgery, the da Vinci robot provides the surgeon with improved visualization, dexterity, and precision compared with open or laparoscopic surgery, while enabling operation through 1-2 cm incisions.
• The precision of the da Vinci system also allows the surgeon to avoid damaging healthy prostate tissue, which improves clinical results, reduces scar tissue build up, and contributes to an overall shorter recovery period after robotic prostate surgery.

If you have any questions about the da Vinci robotic prostate cancer surgery system or other details about prostate cancer, please feel free to contact us here.