da Vinci Robotic Surgery for Prostate Cancer in India - Best Cancer Hospital India

da Vinci Robotic Surgery for ProstateCancer

Robotic laparoscopy prostatectomy offers several advantages. Although experts do not agree as to whether robotic or open surgery is best, the majority of prostate cancer surgeries in the U.S. are being done with the laparoscopic/robotic approach, particularly at high volume medical centers that specialize in prostate cancer treatment. The post-operative goals for treating prostate cancer are the same regardless of whether the operation is done with an open or laparoscopic approach.

Less Scaring

The first advantage to robotic surgery is that it is an application of advance technology and is minimally invasive. Instead of having a 5 or 6” incision to the skin and abdominal fascia (See image below, left), patients have a series of small “band-aid” incisions.

A Shorter Hospital Stay

With smaller incisions, the postoperative pain is significantly less, which means your length of hospitalization is shorter - as is the time to return to usual activity. 

After the laparoscopic/robotic prostatectomy patients typically do not require an inpatient hospital stay over one night. Surgery is done in the morning and they typically go home after lunch on the first operative day.  Comparitively, after the open prostatectomy patients spend at least two nights in the hospital primarily for pain control, nausea and difficulty getting out of bed and getting back to an activity level that would be appropriate for them to be discharged home. .

Postoperative Catheterization

The third advantage of robotic surgery over open surgery is a reduction in the required postoperative catheterization time. After open surgery, foley catheters are left to drain the urine for usually two or more weeks. After the robotic approach, the catheter typically remains in place 5 to 7 days. The reason for this difference is unclear but may be related to the increased precision and visibility the robotic approach offers and also maybe that a running anastamosis (bringing the bladder neck and urethral sphincter back together) may be done in a water-tight fashion compared to the open approach.

Erectile Function

The fourth advantage of robotic prostatectomy is the (at least theoretical) improved ability to preserve the erectile nerves. During an open prostatectomy through an incision on the anterior abdominal wall, the nerves that provide erection are hidden behind the prostate. The approach taken using the surgical robot, enters the abdomen and the robotic arms are positioned posterior to the prostate with the nerves directly in front of the robotic/laparoscopic camera. In this way, the nerves maybe preserved, primarily because the anatomy can be seen more clearly compared to open surgery.

Advantages of Roboticprostatectomy

·         Minimal Bleeding  Faster return to normal daily activities .

·         Reduced hospital stay Significantly less pain and scarring

·         Lower blood transfusion rates

·         Improved preservation of physical appearance.

·         Three (3) D vision enables surgeon to perform Prostate excision with Cancer.

·         Control without risk of Post Surgery Continence (control over urinary and fecal discharge) and causing Impotency

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Laser Treatment for Enlarged Prostate (BPH) - Prostate Surgery in India

Diagnosis for Enlarged Prostate (BPH)

Clinical symptoms and physical examination provide the basis for diagnosis of Enlarged Prostate or Benign Prostatic Hyperplasia. The physical examination includes a digital rectal examination (DRE).

Digital Rectal Examination (DRE) 

DRE typically takes less than a minute to perform. The doctor inserts a lubricated, gloved finger into the patient's rectum to feel the surface of the prostate gland through the rectal wall to assess its size, shape and consistency. Healthy prostate tissue is soft, like the fleshy tissue of the hand where the thumb joins the palm. Malignant tissue is firm, hard and often asymmetrical or stony like the bridge of the nose. If the examination reveals the presence of unhealthy tissue, additional tests are performed to determine the nature of the abnormality.

PSA Test

Blood test to check the levels of prostate specific antigen (PSA) in a patient who may have BPH helps the doctor to eliminate the diagnosis of prostate cancer. 

Uroflowmetry Test 

This is a simple test which records the urine flow to determine how quickly and completely the bladder can be emptied. With a full bladder, the patient urinates into a device that measures the amount of urine, the time taken, and the rate of urine flow. Patients with stress or urge incontinence usually have a normal or increased urinary flow rate, unless there is an obstruction in the urinary tract. A reduced flow rate may indicate BPH. 

Post-Void Residual (PVR) 

This test measures the amount of urine that remains in the bladder even after urination. The patient is asked to urinate immediately prior to the test and the residual urine is determined by ultrasound. PVR less than 50 ml. generally indicates adequate bladder emptying and measurements of 100 to 200 ml or higher often indicates blockage.

Laser Treatment for Enlarged Prostate (BPH)

Holmium Laser Enucleation of the Prostate (HoLEP)

Holmium Laser Enucleation of the prostate (HoLEP) is a modern alternative to the standard Transurethral Resection of the Prostate (TURP) procedure for bladder outflow obstruction due to BPH. It requires a short period of hospitalisation and an anaesthetic.  A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears. Patients are advised to take life quietly and to avoid straining or heavy lifting for four weeks after the surgery.

Holmium Laser Enucleation of the prostate (HoLEP) is a modern alternative to the standard Transurethral Resection of the Prostate (TURP) procedure for bladder outflow obstruction due to BPH. It requires a short period of hospitalisation and an anaesthetic.  A catheter (a tube which drains the bladder) is also needed for 1-2 days until the urine clears. Patients are advised to take life quietly and to avoid straining or heavy lifting for four weeks after the surgery.

What are the advantages of HoLEP

• There is no upper size limit of prostate that can be dis-obstructed – traditionally men with prostates over 100ml in size needed major open surgery
• There is often less bleeding than after a TURP
• Discharge is often quicker than after TURP at 1-2 days
• The chance of recurrence requiring further surgery is very low
• Unlike greenlight laser operations, large quantities of prostate tissue are sent for pathological analysis
• The PSA generally drops to very low levels after HoLEP operations

Enlarged Prostate or BPH (Benign Prostatic Hyperplasia) Treatment in India

Enlarged Prostate or BPH (Benign Prostatic Hyperplasia) is a natural condition where the prostate gland slowly grows, causing pressure on the urethra, similar to a clamp on a garden hose.

Common Symptoms of enlarged prostate include:

• Frequent urination, especially at night
• Sudden need to urinate
• Difficulty beginning urination
• Pain or burning
• Feeling that your bladder never completely empties
• Dribbling or leaking
• Weak urine stream

Loss of Personal Freedom

Many men report changes to lifestyle such as avoiding travel, interruption of leisure activities and using bathroom stalls instead of urinals. Frequent trips to the bathroom can disrupt sleep.

A Simple and Effective Solution

If these symptoms are familiar to you, or if you are changing your lifestyle to accommodate urinary problems, you should know that there is a simple solution. It is called GreenLight™ Laser Therapy. This therapy can free you from urinary problems without compromising lifestyle or health, giving you the green light to live life the way you want to, without compromise.

Understanding the Prostate

The prostate is a walnut-sized gland that forms part of the male reproductive system. The prostate secretes fluid that carries sperm. It surrounds the urethra, the canal which carries urine from the bladder out of the body.

With age and time, the prostate enlarges causing pressure on the urethra, similar to a clamp on a garden hose. This causes problems with urination.

Words to Know

• Prostate — A walnut-sized gland that secretes prostatic fluid which carries sperm
• Benign Prostatic Hyperplasia (BPH) — A non-cancerous enlargement of the prostate that restricts urine flow
• Incontinence — Inability to control or hold back urine
• Impotence — Failure to achieve or to maintain an erection
• Retrograde Ejaculation — When semen travels up the urethra towards the bladder instead of outside of the body
• Catheter — A thin, flexible tube inserted through the penis used to drain urine from the bladder
• Cystoscope — An instrument that allows the doctor to examine the bladder and prostate

Diagnosis

You may first notice symptoms of enlarged prostate (BPH) yourself, or your doctor may find that your prostate is enlarged during a routine checkup. When enlarged prostate (BPH) is suspected, you may be referred to a urologist, a doctor who specializes in problems of the urinary tract and the male reproductive system. Several tests help the doctor identify the problem and decide the best course of treatment. The tests vary from patient to patient, but the following are the most common.

Digital Rectal Exam (DRE)

This exam is usually the first test done. The doctor inserts a gloved finger into the rectum and feels the part of the prostate next to the rectum. This exam gives the doctor a general idea of the size and condition of the gland.

Prostate Specific Antigen (PSA) Blood Test

In order to rule out cancer as a cause of urinary symptoms, your doctor may recommend a PSA blood test. PSA, a protein produced by prostate cells, is frequently present at elevated levels in the blood of men who have prostate cancer.

Rectal Ultrasound

If there is a suspicion of prostate cancer, your doctor may recommend a test with rectal ultrasound. In this procedure, a probe inserted in the rectum directs sound waves at the prostate. The echo patterns of the sound waves form an image of the prostate gland on a display screen.

Urine Flow Study

Sometimes the doctor will ask a patient to urinate into a special device which measures how quickly the urine is flowing. A reduced flow often suggests BPH.

Intravenous Pyelogram (IVP)

IVP is an x-ray of the urinary tract. In this test, a dye is injected into a vein, and the x-ray is taken. The dye makes the urine visible on the x-ray and shows any obstruction or blockage in the urinary tract.

Cystoscopy

In this exam, the doctor inserts a small tube through the opening of the urethra in the penis. This test allows the doctor to determine the size of the gland and identify the location and degree of the obstruction.