Newer surgery technique

In reply to someone’s post I wrote about this new surgical procedure but realize if it is not a stand alone post, many may not have seen it unless they decided to read that person’s post and comment’s which can fade fast. This post is not to try and dissuade anyone from the treatment they are leaning towards, it is just to make sure that any surgery leaning members evaluate and know surgery options.

Most patients , myself included believed all robotic laparoscopic prostatectomies were the same procedure. They are NOT! A key factor in choosing your Surgeon during consultation’s, if going with Surgery is to be aware that technologies and techniques are advancing in the field. The most up to date and advanced robotic surgery is done with the DaVinci single port robot. If your surgeon is not using the latest DaVinci Robotic model it does not change his ability in performing an outstanding surgery, but it can affect a quicker recovery, and not have the ability for state of the art surgical techniques that can alleviate the severity of possible side effects by using the newer robot.
The newer DaVinci Robotic single port (latest) makes one small incision for entry as opposed to the older widely used DaVinci model making as many as 6 small incision entries. The single port barely leaves a scar and you can leave the hospital the same day as your surgery. My surgery was in the morning 7:30am and discharged around 5:30pm. I am now 18 months post surgery and the single tiny scar is almost unnoticeable.

Nerve sparing is very important but even more important today is the newer Retzius sparing surgical technique which generally gives immediate continence upon the catheter removal and improves ED.

In the newer surgical technique the surgeon leaves intact and does not cut the puboprostatic ligament holding the bladder in place and this maintains urethral length upon reattachment to the bladder which substantially improves the likelihood of minimal post leaking if none at all. This is very important and most surgeons are not trained in this latest technique. It is called Retzius sparing. The part of the surgery in which the surgeon reattaches your urethra to your bladder is a significant part of the completion of the prostatectomy surgery. In this Retzius sparing technique the surgeon accesses the bladder from behind allowing the ligament not to be cut. You are positioned differently than in a normal robotic prostatectomy because of coming in reverse. Most patients after a prostatectomy comment on the loss of penile length. This is typically caused by the need to cinch up and reattach the urethra to a bladder that had its Puboprostatic Ligament cut and not where it was. Almost all Surgeons cut this ligament to do surgery because it is how they need to access the prostate from the normal prostatectomy surgery, however the new surgery procedure, not really new, it has been around a number of years now having come from Europe is that they go in to remove the prostate doing surgery from coming in behind the bladder, to gain access to the prostate and do not need to cut the ligament . Not only as previously reported that you do not lose penile length as the reattachment is right back to the place where the stable bladder is still positioned and the urethra was cut from, but it seems according to most literature on this, most patient’s have almost immediate continence. These certainly are the two major concerns of patients I hear about regarding surgery. The third concern is the sexual function more involved with nerve sparing and alot of that involves a surgeon’s skill around the nerve bundles. Even if the cancer has seemed to leave the capsule, a surgeon can spend extra time delicately getting to a negative margin and as in my case , nerves spared one side, half the other and 18 months post surgery, early 70’s, I am good to go fully erect penetration in the morning on an empty stomach after 4 pills sildenifil (20mg a piece) total 80mg and waiting 75 minutes. Many patients don’t realize or even know of this new surgical approach, I did not. This really shows how important it is to research your surgeon and see what robotic laparoscopic prostatectomy surgery he performs. You really have to look for this specific surgeon and consult with or call around the major hospitals to see if they have surgeons doing this technique. This still by far is not the common surgery technique but is gaining substantially more traction each year as newer surgeons who are staying up to date on the latest technology and techniques are performing it. It will likely become the standard over time due to the success in reducing side effects especially of incontinence, ed and penile length. Many major hospitals still don’t have a surgeon trained this way, it’s just finding that Surgeon and not just relying on the surgeon referral you are given by your urologist after your cancer diagnosis.
Also another very important factor in surgeon consideration is whether during surgery while you are on the table he will send the sliced prostate bed tissue and lymph nodes immediately to Pathology for inking and staining to rule out whether the cancer has left the capsule, even if the PET says it had not entered the bed or lymph nodes and is localized to the capsule. Then if pathology reports positive margin in the bed the Surgeon can go back in deeper while your are on the table to try to eliminate the positive margin. This happened in my case adding an additional two hours to my surgery with the initial positive margin coming back. Even my surgeon was surprised from his visual of inside me and the of hundreds of surgeries he has seen, and said on occasion he gets surprised. That is even though the PET suggested everything was contained. Most surgeons don’t do this and accept that the PET says it is contained and the surgeon cuts the normal surgical margins and removes some nodes and closes you up. Then at your post surgical appointment you may be told, sorry there was positive margin. Well it’s a little late I would say to hear that. In mine at that post appointment I was told final pathology with negative margin had been achieved. This additional step can really mess up a surgeon’s operating schedule, not only the time waiting for Pathology but additional time back in surgery if necessary. On their surgical day surgeons often have a morning and afternoon procedure scheduled if they need to go back in unexpectedly for several hours that was not planned, it substantially delays the afternoon procedure and for the day adds that much extra time to the Surgeon’s day. This is a major reason they don’t even if they have pathology available. For this to be done the surgery needs to be performed at a major hospital that has Pathology inhouse.

I hope this is informative for many.