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Robotic Prostate Surgery

Grand Strand Medical Center and Atlantic Urology Clinics are proud to be the first in South Carolina to offer a new technology for robotic prostate surgery. Through the use of ProPep Surgical and the da Vinci® robotic assisted surgery system, Timothy Gajewski, MD-Urologist, uses a nerve monitoring technology that helps reduce erectile dysfunction and urinary incontinence which are common side effects of prostate cancer surgery.
Grand Strand Medical Center and Atlantic Urology Clinics are proud to be the first in South Carolina to offer a new technology for robotic prostate surgery. Through the use of ProPep Surgical and the da Vinci® robotic assisted surgery system, Timothy Gajewski, MD-Urologist, uses a nerve monitoring technology that helps reduce erectile dysfunction and urinary incontinence which are common side effects of prostate cancer surgery.

Importance of Robotic Assisted Surgery

Robotic laparoscopy prostatectomy offers several advantages.

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. (On right)

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.

Comparatively, 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.

Less Drugs, More Blood

Patients’ need for postoperative pain medicine and narcotics is also greatly reduced after the laparoscopic/robotic approach compared to open surgery.

Another advantage to robotic surgery is decreased intraoperative blood loss. During traditional open surgery, it is not at all uncommon for patients to lose between 600 cc and 1000 cc of blood intraoperatively given the intense vascularity of the prostate and its surrounding tissues. This entails some significant risk of intraoperative or postoperative transfusion (and secondarily the attendant risk of transfusion) among these patients.

During robotic/laparoscopic prostatectomy, blood loss is usually 200 cc or less, which is very minimal and has a negligible risk of needing a transfusion. This is likely a minor difference as the transfusions are quite safe. However, the small difference among treatment approaches may be quite important to some patients.

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.

In addition, the decreased blood loss of the robotic approach improves the intra-operative visibility. As you can imagine, attempting to preserve delicate nerve structures can be quite challenging in the pool of blood versus in a relatively dry surgical field that is expected with the laparoscopic/robotic approach.