Prostate cancer (also known as prostate carcinoma) is one of the most common cancers in men. After lung cancer and bowel cancer, prostate cancer is the third most common fatal cancer. If prostate cancer is detected early, the chances of recovery are very good. In the field of surgery, the state-of-the-art, minimally invasive robot-assisted radical prostatectomy with the da Vinci system is available for prostate cancer.
In the case of localized prostate cancer, complete removal of the prostate(radical prostatectomy) is the surgical treatment of choice.
Depending on the access route and type of surgery, radical prostatectomy can be divided into several open and minimally invasive procedures for removing the prostate, for example
Prostatectomy with the Da Vinci surgical system represents a further development of conventional laparoscopic methods in the field of surgery and combines the advantages of laparoscopic prostatectomy with those of open prostatectomy.
During da Vinci surgery, the surgeon is assisted by robotic arms to guide and move around the surgical site.
The walnut-shaped prostate (prostate gland), which is around four centimetres in size, is located in men directly below the bladder and surrounds the urethra, through which urine is drained from the bladder to the outside.
The risk of cancer developing in the prostate increases significantly with age. Prostate cancer is practically non-existent under the age of 40. Studies have shown that the probability of developing prostate cancer increases 40-fold between the ages of 50 and 85.
Unfortunately, there are notypical symptoms in the early stages of prostate cancer; those affected often do not notice the growing tumor in the prostate at first. Only as the cancer progresses do symptoms appear, which are often due to a narrowing of the urethra or blockage of the urine outflow as a result of the enlarged prostate.
This manifests itself in particular through problems urinating, such as
However, it can also lead to
may occur. If metastases have already formed, there is increasing pain in the spine and pelvic area.
During a screening examination, despite the absence of symptoms, the doctor can diagnose prostate cancer using
can provide an initial indication of tumor growth in the prostate.
He will then initiate further examinations such as ultrasound and MRI. Only by taking a tissue sample from the prostate (biopsy) is it certain whether or not a prostate tumor is present.
The treatment options for prostate cancer depend on several factors such as the stage of the cancer, age and state of health as well as the man's personal preferences. The stage categorization is based on whether the tumour is still confined to the prostate (early stage) or whether it has already spread to neighbouring tissue or metastasized (advanced stage).
Your doctor will give you detailed advice on this. If necessary, you should also seek advice from several urologists to ensure that you receive the best treatment for you.
Depending on the stage of the prostate carcinoma, there are various treatment options:
If the cancer has not yet spread to neighboring tissue or formed metastases, the tumor can be completely removed by removing the prostate (prostatectomy); the chances of recovery are then excellent.
In a radical prostatectomy, the seminal vesicles and the prostate capsule are removed as well as the entire prostate and, if necessary, the pelvic lymph nodes.
In addition to open surgery, i.e. the "classic" opening of the abdominal wall as in radical retropubic prostatectomy or radical perineal prostatectomy, minimally invasive procedures (e.g. laparoscopic (transperitoneal) radical prostatectomy or endoscopic extraperitoneal radical prostatectomy) are also used in specialized clinics.
The advantages of a minimally invasive surgical procedure over open surgery are obvious: the smaller incisions result in less wound pain and less blood loss
The Da Vinci surgical system is a complex surgical system with which three-dimensional images in HD quality can be displayed at a special operating station. The surgeon does not operate on the patient himself, but with special instruments at the Da Vinci station. The robotic arms then carry out the movements with extreme precision and absolutely no jitter.
This allows surgical procedures to be performed that are no longer possible with the human hand.
Even though the Da Vinci surgical system is often referred to as a Da Vinci surgical robot, it is not a robot that can perform operations independently. Da Vinci surgery is performed by the surgeon alone. The Da Vinci system facilitates the operation and overcomes certain limitations of conventional open and laparoscopic prostatectomies.
The Da Vinci surgical system developed in the USA has been in use since 2000 and has almost completely replaced conventional laparoscopy in many areas in the USA. Da Vinci surgery is also becoming increasingly widespread in Germany.
Da Vinci surgery is not only used for the treatment of prostate cancer, but also for other diseases such as
In minimally invasive prostatectomies, the surgical area is very confined. There are also nerves in this area that influence the erection and the sphincter muscles on the urethra.
If these nerve cords are damaged during the operation, this often results in impotence and urinary incontinence.
The Da Vinci surgical system is therefore particularly suitable for such relatively complicated urological procedures. The surgeon can see high-resolution images of the organ and can better recognize all structures under magnification. The robotic arm is more precise than the human hand.
As a result, complications such as urinary incontinence and impotence occur less frequently, as the robot-assisted Da Vinci operation is extremely precise and the urethral sphincter and nerves in the operating area are optimally protected. According to the manufacturer of the Da Vinci surgical system, Da Vinci prostatectomy has the following advantages over an open prostatectomy:
Below you will find out how a da Vinci operation is performed.
Once the patient has decided to have da Vinci surgery, a physical examination is carried out again. The doctor may also prescribe certain exercises, diets or medication for the patient before the operation.
The surgeon informs the patient about the details of the da Vinci operation, the risks involved and any complications that may occur. An anesthesiologist usually informs the patient about the upcoming anesthesia in the week before the procedure.
The evening before the da Vinci operation, the patient must follow the bowel preparation instructions given by the doctor.
The patient is put under anesthesia by an anesthesiologist for the duration of the da Vinci prostatectomy, which is usually two to four hours.
The individual steps of the subsequent operation are as follows:
If the extent of the tumor allows, the surgeon tries to preserve the nerves attached to the prostate. These fine nerves surround the prostate like a spider's web and react very sensitively to pressure and heat.
Once the prostate and the surrounding tissue have been removed from the body using the surgical instruments, the ports are removed from the abdominal wall and the incisions are closed with a suture or a plaster.
The patient usually spends the first night after the da Vinci operation in hospital to recover from the anesthetic. This also allows any discomfort associated with the anaesthetic to be treated and any complications to be identified. However, the patient should be able to sit, stand up and walk around again quickly, which will aid the recovery process.
If there are no complications and the symptoms have subsided, the patient can go home. Although they should recover during the first week, it is recommended that they walk frequently and a lot during this time. Many patients are able to go about their daily routine as usual just a few days after da Vinci surgery. However, it takes around four weeks before the patient can lift heavy loads and carry out strenuous activities again. This is how long it takes for the wounds inside the body to heal.
To enable urination after prostate removal, a catheter was inserted into the patient's bladder during the da Vinci operation. This remains in place for around seven days. During this time, the patient must follow certain rules of conduct to ensure that the catheter functions properly. After about a week, the catheter is removed and the bladder function is checked using a saline solution and natural urination. This often reveals a certain degree of urinary incontinence. This is treated with medication and usually subsides.
If nerve fibers are damaged, impotence ( erectile dysfunction) may occur. This complication can also subside over time or disappear completely. It can usually be treated with medication.
As after any surgical treatment of prostate cancer, the patient must also be examined regularly after a da Vinci operation. The examination intervals and follow-up examinations (PSA value, digital rectal examination) are set out in the aftercare plan.
By determining the PSA value, it is often possible to determine at an early stage whether the carcinoma is growing again or whether metastases have formed. For this reason, shorter intervals for PSA determination are often recommended following a da Vinci prostatectomy. In the long term, the PSA value is then checked once a year.
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