Oncology, urology  

Robotic prostatectomy protects sexual function

Detroit, USA. Patients who underwent a robotic radical prostatectomy had significantly better erectile function outcomes than those who received conventional nerve-sparing surgery — without compromising cancer control, according to a year-long study conducted by doctors at Henry Ford Hospital's Vattikuti Urology Institute.

The results should help ease men's concern as to the future of their sex lives when faced with a radical prostatectomy, the surgical removal of the prostate and surrounding tissue, one of the most effective prostate cancer treatments.

"The potency outcomes with our robotic surgery are the highest reported to date," said Mani Menon, M.D., director of the Vattikuti Urology Institute. "Of the patients undergoing the procedure, 97% achieved erections strong enough for intercourse —with about half not requiring medication to do so." Sexual function was assessed by having the men fill out questionnaires a year after the operation.

The institute has performed more than 2,100 robotic prostatectomies, more than any other hospital in the world. The study is published in the December issue of the Journal of Urology.

While the main objective of a radical prostatectomy is cancer control, maintaining the patient's quality of life is an important secondary goal. Many studies have shown that the most common factor, which decreases quality of life is reduced erectile ability. While more conventional procedure leaves most men with some erectile function, many find their erectile ability has decreased.

In addition to lowering the risk of impotence, robotic surgery significantly reduces pain, blood loss, risk of incontinence, and recovery time, compared with the traditional radical prostatectomy.

In the robotic procedure, which was developed at the Vattikuti Urology Institute, doctors use a robotic arm to perform the surgery. The surgical site is magnified 35 times, enabling the surgeon and team to have better with the instruments and increase ability to identify areas where the cancer may have spread. The technique, that the Menon team developed, and is not available elsewhere for the moment, preserves the prostatic fascia, which appears to improve the quality of nerve preservation during the robotic prostatectomy.

The procedure is performed in an operating room with three-dimensional technology and two 60-inch by 80-inch flat projection screens, along with advanced lighting and a data monitoring and intercom system. The surgical team works in 3-D wearing special polarized glasses.

Using a tiny camera at the end of a laparoscope, the surgeon can operate miniaturized instruments at the end of other laparoscopes from a remote console.

Henry Ford Hospital has two da Vinci Robotic Surgical Systems that are used to perform robotic prostatectomies as well as other procedures.

Prostate cancer is the second most-common cancer in men next to skin cancer. The American Cancer Society estimates that more than 232,000 new cases will be diagnosed this year in the United States, and more than 30,000 men will die from the disease. Prostate cancer is the second-leading cause of cancer death among men in the country.

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