The Role of Nerve-Sparing Techniques in Robotic Prostate Cancer Surgery
By Dr. Anup Ramani
Prostate cancer is one of the most commonly diagnosed cancers in men. As the medical field continues to evolve, prostate cancer surgery has undergone significant advancements, with robotic prostate cancer surgery, becoming the treatment of choice for many patients. This innovative approach offers numerous advantages over traditional open surgery, including reduced recovery times, minimized risk of complications and improved precision.
One of the most critical aspects of robotic prostate cancer is the ability to incorporate nerve-sparing techniques. The prostate is located near vital nerve structures that control erectile function and urinary continence and preserving these nerves during surgery can significantly improve a patient’s quality of life post-surgery. This article focuses on how nerve-sparing techniques in robotic prostate cancer surgery contribute to better functional outcomes and recovery for prostate cancer patients.
What is the Role of Nerve-Sparing Techniques in Robotic Prostate Cancer Surgery?
Nerve-sparing techniques are designed to preserve the nerves surrounding the prostate that control erectile function and urinary continence. In robotic radical prostatectomy, the surgeon aims to remove the prostate gland while sparing these vital nerve structures whenever possible.
Nerve-Sparing in Robotic Surgery
During robotic prostate cancer surgery, the robotic system’s high-definition camera and instruments give the surgeon a clearer view of the prostate and surrounding structures. This precision enables the surgeon to preserve the neurovascular bundles, which may not have been possible with traditional surgical methods. By preserving these nerves, the surgery aims to reduce the risk of post-surgical erectile dysfunction and urinary incontinence, which are common concerns for patients undergoing prostate cancer surgery.
Why Nerve-Sparing Matters?
The preservation of erectile function and urinary continence is crucial for many prostate cancer patients. After surgery, many patients fear a loss of sexual function and the possibility of needing to use incontinence pads or undergo further treatments for bladder control. Nerve-sparing techniques, therefore, aim to improve these outcomes by providing a more functional recovery post-surgery, enhancing the patient’s overall well-being.
When are Nerve-Sparing Techniques Used in Robotic Prostate Cancer Surgery?
Nerve-sparing techniques are not always appropriate for every patient. The decision to preserve the nerves during robotic prostate cancer surgery depends on several factors, including the stage and location of the cancer, as well as the patient’s health and anatomy.
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Localized Cancer
Nerve-sparing techniques are typically reserved for patients with localized prostate cancer – those whose cancer has not spread to surrounding tissues or the neurovascular bundles. If the cancer is confined to the prostate and not near the nerves, there is a greater likelihood of being able to preserve these critical structures during surgery.
Tumor Invasion
If the cancer has spread into the surrounding tissues or is located near the neurovascular bundles, nerve-sparing surgery may not be feasible. In these cases, the surgeon may need to prioritize the complete removal of cancerous tissue, which might involve sacrificing some or all of the nerves. Although this decision can result in a loss of erectile function or urinary continence, it is sometimes necessary to ensure that all cancerous tissue is removed.
Patient and Surgeon Factors
The suitability of nerve-sparing techniques also depends on the individual patient’s anatomy and the surgeon’s expertise. Surgeons with experience in robotic radical prostatectomy and nerve-sparing procedures are more likely to be able to preserve these critical nerve structures safely. Additionally, patient factors such as age, general health and expectations play a role in determining whether nerve-sparing is appropriate.
Where Does Robotic Prostate Cancer Surgery Fit into the Overall Treatment Protocol?
Robotic prostate cancer surgery is typically part of a broader treatment plan for patients diagnosed with prostate cancer. Once a patient is diagnosed with prostate cancer, treatment options are considered based on the cancer’s stage, location and overall prognosis.
Initial Diagnosis and Staging
The first step in determining whether robotic prostate cancer surgery is an appropriate treatment is the diagnosis and staging process. This includes a combination of PSA testing, digital rectal exams (DRE) and prostate biopsies, as well as imaging techniques like MRI or CT scans. These tests help to determine the cancer’s stage and whether nerve-sparing techniques are viable based on tumor location.
Surgical Treatment
For patients with localized prostate cancer, robotic radical prostatectomy with nerve-sparing techniques may be the treatment of choice. This surgery aims to remove the prostate gland while preserving surrounding nerves and minimizing the risk of recurrence. If nerve-sparing is not possible, patients may be offered alternative treatments, such as radiation therapy, depending on their condition.
Post-Surgery Monitoring and Recovery
After prostate cancer surgery, patients are closely monitored for complications such as infection, incontinence and erectile dysfunction. Depending on the extent of nerve preservation, recovery times for erectile function and urinary continence may vary. Rehabilitation programs, may be recommended to help patients regain control over urinary and sexual function.
Conclusion
Prostate cancer surgery has made significant strides in recent years, with robotic radical prostatectomy standing at the forefront of treatment. The ability to perform nerve-sparing techniques during robotic prostate cancer surgery has revolutionized the patient experience by offering a higher chance of preserving erectile function and urinary continence after surgery.
By incorporating nerve-sparing techniques into robotic prostate cancer surgery, patients benefit from improved post-surgical recovery, fewer complications and enhanced quality of life. While nerve-sparing is not always possible for every patient, particularly those with advanced cancer, it remains a critical approach for those with localized prostate cancer.
With continued advancements in robotic technology and surgical expertise, the future of prostate cancer surgery looks brighter, with more patients able to achieve both oncological success and functional preservation after surgery.
FAQs
What is robotic prostate cancer surgery?
Robotic prostate cancer surgery involves the use of robotic-assisted technology to perform robotic radical prostatectomy, a procedure where the prostate gland is removed with minimal incisions. This technique offers enhanced precision and faster recovery compared to traditional open surgery.
What are nerve-sparing techniques in prostate cancer surgery?
Nerve-sparing techniques aim to preserve the neurovascular bundles during robotic prostate cancer surgery, which control erectile function and urinary continence. This helps to minimize post-surgical complications such as erectile dysfunction and incontinence.
Can all prostate cancer patients undergo nerve-sparing surgery?
Nerve-sparing surgery is typically only suitable for patients with localized prostate cancer. If the cancer has spread to surrounding tissues or is near the nerves, nerve-sparing may not be possible.
How does robotic prostate cancer surgery differ from traditional surgery?
Robotic prostate cancer surgery is Minimal invasive, requiring only small incisions. It provides greater precision, a higher chance of preserving nerves and faster recovery times compared to traditional open prostatectomy.
How long does it take to recover from robotic prostate cancer surgery?
Recovery time varies, but most patients experience shorter hospital stays and quicker returns to daily activities compared to traditional surgery. Post-surgery rehabilitation, including pelvic floor exercises, may be recommended for better recovery outcomes.
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PARTIAL PENECTOMY
- Partial penectomy is done in cases where glans and distal penis is involved with carcinoma.
- Partial penectomy is a type of organ-preserving surgery. Preservation of sexual and micturational function depends on the surgical dissection and reconstruction of residual urethra.
Kidney Stone Removal
- Patients who develop stones in the kidney or ureter, often experience severe pain.
- This condition usually needs a procedure to remove the kidney stones.
- This procedure is called ureteroscopy and is performed very commonly.
- It does not require any cuts and hence it is painless.
- The procedure is performed with an endoscope inserted through the penis under spinal anesthesia.
- The scope is inserted through the penis into the kidney and stones are dissolved with a laser.
- The procedure takes about 40-50 minutes.
- A catheter (urine pipe) is kept after the procedure to drain the bladder. A stent is kept in the kidney at the same time.
- Patient is mobile and walking in the room the same evening.
- Hospital stay is one night and patient is discharged the next day after removal of the catheter.
- Patient has to come back after six weeks to remove the stent in the kidney.
- Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
- We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
- Men with an enlarged prostate, which is a normal ageing changes, often experiencing difficulty passing urine. This condition usually needs a procedure to trim the prostate and relieve the blockage.
- This procedure is called TURP and is performed very commonly.
- It does not require any cuts and hence it is painless.
- The procedure is performed with an endoscope inserted through the penis under spinal anaesthesia.
- The overgrown prostate is dissolved with a laser bloodlessly.
- The procedure takes about 40 minutes.
- A catheter (urine pipe) is kept after the procedure to drain the bladder.
- Patient is mobile and walking in the room the same evening.
- Hospital stay is two nights and patient is discharged with the catheter, which is removed after 4 days.
- Patients can resume office a week after surgery and heavy activities like running, weight lifting, a month after the procedure.
- We offer fixed packages for this procedure which can be obtained by calling our helpline +91 9967666060.
ROBOTIC ADRENALECTOMY FOR ADRENAL GLAND TUMOUR
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Robotic adrenalectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
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Once the anesthesia is done, and patient positioned, three micro cuts (3mm each) are made in the patient’s abdomen.
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The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
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Dr. Ramani then sits in the controlling console to perform the surgery.
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On an average, a robotic adrenalectomy takes one hour.
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The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
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A urine catheter and bag to drain the bladder is inserted during surgery.
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A tiny drain pipe may be inserted in the surgical side of the abdomen, connected to a bag.
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Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
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The drain pipe, if kept, is removed in the room on day 2 after surgery.
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The catheter is removed on day two after surgery.
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Total hospital stay for robotic adrenalectomy is 4 nights (including night before surgery).
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Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home. Almost all patients are back to work within 2 weeks of surgery.
Heavy activities like running, weight lifting can be resumed after a month
FOLLOW UP AFTER SURGERY
Follow up after an adrenalectomy is in the form of CT scans, once a year for 5 years.
Local patients usually meet Dr. Ramani after two weeks to discuss report.Outstation patients are counselled on a phone consultation.
ROBOTIC SURGERY FOR BLADDER CANCER
- Dr. Ramani is one of the very few surgeons in India who has the expertise to perform a robotic surgery for bladder cancer, which includes removing the urinary bladder and reconstructing a new bladder robotically.
- Robotic radical cystectomy is an extremely sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications.
- Once the anaesthesia is done, and patient positioned, six micro cuts (3mm each) are made in the patient’s abdomen.
- The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
- Dr. Ramani then sits in the controlling console to perform the surgery.
- On an average, a robotic radical cystectomy with an ileal conduit takes 3-4 hours.
- The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
- A urine catheter and bag to drain the new bladder is inserted during surgery.
- Two tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
- Patient is kept nil-by-mouth for 4 days after surgery with IV supplementation of patient’s daily requirements of calories, fats, carbohydrates, proteins and electrolytes.
- The drain pipes are removed in the room on day 3-5 after surgery.
- Total hospital stay for radical cystectomy is 8 nights (including night before surgery).
- Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
- On the day of discharge, patient is totally self-sufficient. They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
- Almost all patients are back to work within 6 weeks of surgery. Heavy activities like running, weight lifting can be resumed after two months.
FOLLOW UP AFTER SURGERY
Follow up after a radical a cystectomy is in the form of CT scans, once a year for 5 years.
Histopathology report: Local patients usually meet Dr. Ramani after two weeks to discuss report.
Outstation patients are counselled on a phone consult. Depending on the report, patient may or may not need chemotherapy after surgery.
If chemo is needed, patients may choose to get it done with a medical oncologist of their choice or avail the services of one of the four medical oncologists on our team.
ROBOTIC RADICAL/PARTIAL NEPHRECTOMY FOR KIDNEY CANCER
- Robotic partial nephrectomy is a sophisticated, complex surgery and it is very important that an experienced surgeon performs this surgery to avoid major complications. Robotic radical (total) nephrectomy is
- relatively easier but still requires significant experience to consistently deliver results.
- Once the anaesthesia is done, and patient positioned, five micro cuts (3mm each) are made in the patient’s abdomen.
- The arms of the Da Vinci robot are connected to the cuts via ports (tubes).
- Dr. Ramani then sits in the controlling console to perform the surgery.
- On an average, a robotic radical nephrectomy takes one hour and a robotic partial nephrectomy takes about an hour and half.
- The surgery is almost completely bloodless and there has never been any need to transfuse blood after surgery.
- A urine catheter and bag to drain the bladder is inserted during surgery.
- A tiny drain pipe in inserted in the surgical side of the abdomen, connected to a bag.
- Patient is kept nil-by-mouth the day of the surgery, with IV fluids. Sips of water are started the next day and solid food by day three.
- The drain pipe is removed in the room on day 3 after surgery. The catheter is removed on day two after surgery.
- Total hospital stay for radical/partial nephrectomy is 4 nights (including night before surgery).
- Post discharge, a doctor from the surgical team visits the patient at home/ hotel room once every day.
RETURN TO ACTIVITY
- On the day of discharge, patient is totally self- sufficient.
- They are able to walk freely without any pain, dress themselves, shower, toilet and they do not need to hire any nurse or help at home.
- Almost all patients are back to work within 2-3 weeks of surgery.
- Heavy activities like running, weight lifting can be resumed after a month.
FOLLOW UP AFTER SURGERY
- Follow up after a radical/partial Nephrectomy is in the form of CT scans, once a year for 5 years.
- Local patients usually meet Dr. Ramani after two weeks to discuss report.
- Outstation patients are counselled on a phone consultation.