Download PVFM: Paradoxical Vocal Fold Motion

Robotic-assisted
Laparoscopic Prostatectomy
Blake W. Moore, MD
Virginia Urology
Prostate Cancer
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Prostate cancer (PCa) is the most frequently
diagnosed cancer in American men
Lifetime risk of PCa diagnosis is ~16%
Screening has profoundly affected the diagnosis and
treatment of PCa and enabled physicians to detect
prostate tumors while they are still potentially curable.
Prostate Cancer
Surgical Treatment
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Prostatectomy overall is a safe operation with very low
risk of major operative complications
It is the gold standard of treatment for PCa
The downside of surgical treatment for PCa is the
potential post-operative side effects
The two most bothersome potential side effects of
prostatectomy are incontinence and erectile
dysfunction
Despite advances in surgical technique, rates of
incontinence following prostatectomy still range from
5-10% and rates of erectile dysfunction range from 2550%
Prostate Anatomy
Prostate Anatomy
Prostate Anatomy
Prostate Anatomy
Robotic
vs.
Open
Surgery
Majority of cases now performed robotically rather
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than open (>85%)
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Potential benefits include improved visualization,
more precise movements, loss of tremor, improved
ergonomics for the surgeon, decreased blood loss,
faster recovery compared to open surgery (less pain)
Based on multiple studies, may have faster recovery
of continence and overall improved ED and
continence
Potential disadvantages include lack of tactile
sensation, limitation of movements, and cost
(increases cost by $1-5K)
? Prior surgery, increased patient weight, high grade
cancer
Open Procedure
Robotic Procedure
Surgeon’s Console
The Patient-side Cart
Endowristed Instruments
Robotic Prostatectomy
Steps:
1.
Drop bladder from anterior abdomen
2.
Divide prostate from bladder neck
3.
Divide vascular pedicles of prostate using clips
4.
Detach seminal vesicles
5.
6.
Depending on disease: Laterally separate
prostate from neurovascular bundle (nerve
sparing) Vs. wide resection [athermal technique]
Separate the dorsal venous complex from above
the prostate & suture closure DVC
7.
Divide urethra from prostate
8.
[Optional] Pelvic lymphadenectomy
9.
Urethro-vesical anastamosis
10.
Bag and extract specimen
Robotic Prostatectomy
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Basics
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Complete removal of prostate and seminal vesicles
Minimize use of electrocautery (thermal energy) posterio-laterally near
NVB
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Minimize trauma to the urethra and pelvic floor
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Maximize urethral length
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Watertight urethro-vesical anastamosis (short catheterization period)
Continues to be one of the most technically
demanding urologic operations
Patient functional and oncologic outcomes,
complications are closely tied to surgeon technical
abilities and experience
What to expect post-op
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Majority of patients (>90%) leave after one night
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5-7 days with a foley catheter
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No heavy lifting for 4 weeks
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Discuss pathology at 1 week follow-up when catheter
is removed
First PSA check at 4-6 weeks after surgery
Thank you