Robot-assisted laparoscopic radical prostatectomy
The da Vinci robot has revolutionised the surgical removal of the prostate as a treatment for cancer. In the USA, there are now over 600 robots in use; however in the UK, there are currently only just over 30 and as yet very few surgeons have extensive experience of the technique. The number of cases performed by our Prostate Centre team outrivals most in the UK. You can be confident that your surgeon, anaesthetist and back-up team have worked together since initial training and are highly experienced in looking after patients who choose this treatment option.
Who is it suitable for?
Men who are in good general health, aged under 75 (depending on the individual) and whose cancer is localised to the prostate gland. Men with urinary problems due to an enlarged prostate will have these symptoms relieved.
How does it work?
The da Vinci machine provides a minimally invasive means of removing the prostate gland via 6 small key hole perforations rather than one longer incision.
The robot does not perform the operation. Its movements are controlled precisely by the surgeon, who is seated in the same room but away from the patient and is able to carry out precise and controlled movements using tiny, 7mm instruments at the end of the robotic arms. These instruments have a 360º range of movement and can be manipulated intricately because of the powerful 10x magnification and 3D view that the surgeon has at the console. They dissect the delicate structures, eliminating the tremor associated with traditional laparoscopy.
The benefits compared with traditional “open” prostate surgery may include reduced risk of sexual dysfunction and incontinence due to better visualization of the anatomy; although some impairment of these functions remain a common, often temporary, side-effect. There is also less scarring, much less blood loss and less pain, leading to a shorter hospital stay, faster removal of catheter, quicker recovery and return to normal activities with extremely high cure rates.
The procedure is approved by NICE (National Institute for Clinical Excellence).
Where is it done?
Our team uses The Princess Grace Hospital, which is one of the few hospitals in the country to have the latest-generation da Vinci ‘S’ machine together with High Definition technology.
How much does it cost?
Self-funding patients can expect to pay around £20-£24,000 for this procedure. Insured patients are normally covered, sometimes in full but in many cases with a considerable shortfall in benefit which has to be paid personally. It is therefore vital to make sure you understand any limits to your cover before proceeding to book this operation.
What is The NeuroSAFE procedure?
This procedure can be incorporated into a radical prostatectomy if the surgeon has concerns that sparing the nerves by dissecting very close to the capsule of the prostate, may uncover the cancer. The procedure involves the prostate being examined carefully by a pathologist during the operation (this is called a frozen section) so that if, having spared the nerves, cancer cells are seen at the edge of the prostate, the nerve can be resected on the side in question. The operation duration is increased slightly meaning that the cost of the operation may be higher (although the insurance companies will cover most of this cost, they will not cover it all).
Our comments on Retzius surgery
Retzius sparing refers to preservation of the structures anterior to the prostate itself. These structures include the ligaments which support the bladder neck promoting urinary incontinence. What data is available on this technique suggests that, whilst patients leak urine for less time after radical prostatectomy, in the longer term the degree of return of continence is similar. One concern that has been raised by the people who evaluated this technique in clinical trials is the increased rate at which cancer is found at the edge of the resected prostate, a so called positive surgical margin, which is linked to a decreased chance of cure (16.7 with Retzius sparing versus 7.7 % with a standard technique for cancer confined to the prostate and 31.8% vs 14.3% once the cancer had started to invade through the capsule of the prostate). As such the technique is only really appropriate for small, low grade cancers, the sort of cancers which are not usually treated surgically nowadays. For this reason we do not advocate a Retzius sparing approach as we believe that cancer control should not be jeopardised.