Q. Why would anyone want a robot anywhere near his prostate?

By S. Adam Ramin, M.D., urology cancer specialist at Saint John’s Health Center and among the first few surgeons in the country to perform robotic surgery

It sounds unusual, but using the da Vinci robot to perform laparoscopic prostatectomy has many advantages compared to an open procedure and even compared to a conventional laparoscopic procedure.

First, let me explain how robotic surgery works. Like in laparoscopic surgery, a camera is placed through the belly button, and the surgical instruments are inserted through keyhole incisions in the abdomen. But rather than a surgeon directly holding the instruments, the robot holds them.

The surgeon steers the robot through controls at a console. The robot has four arms that hold instruments. Unlike conventional open surgical or standard laparoscopic instruments, the tips of the robotic instruments have six degrees of freedom, meaning they can bend in any direction, like the human wrist.

When conducted by an experienced surgeon, robotic surgery is a much more accurate operation. When it comes to operating on a man’s prostate, it’s very important to be precise with the dissection.

The three-dimensional view provided by the camera and the dexterity of the robotic hands holding the instruments allow the surgeon to maneuver through and around all those important nerves and vital structures. An experienced robotic surgeon is able to remove all the cancer, while ensuring bladder and sexual functions remain intact.

Patients experience much less pain and blood loss with robotic surgery. They recover and go home faster, have less disfigurement and regain bladder and sexual function sooner.

The good news is that any patient who is a candidate for open surgery is a candidate for robotic laparoscopic surgery. Patients whose prostate cancers are confined to the prostate and not have spread throughout the body are excellent candidates. In addition, many patients who are not good candidates for open surgery, can still have robotic surgery, because it is less invasive.

Patients with multiple medical problems including heart disease, obesity, diabetes, or lung disease might not be able to have open surgery because it would be too taxing on their bodies, so they would normally look to alternative treatment options like radiation. Robotic surgery can be an excellent option for these patients.

I’ve been routinely performing robotic surgery for prostate cancer patients over the past seven years as well as trained many surgeons across the country. In the right hands, robotic surgery is state-of-the art and it can do great things.

S. Adam Ramin, M.D., is a urological oncological surgeon at Saint John’s Health Center. For more information about Dr. Ramin and other Saint John’s services, please call (310) 829-8990 or visit the website at www.stjohns.org. For a physician referral or a second opinion, please call 1-888-ASK-SJHC.

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