Prostate adenoma treatment by da Vinci robot

Da Vinci robot in the treatment of prostate cancer

Da Vinci robot modern technology with a great name

Often, in the case of a diagnosis of prostate cancer, the patient is offered prostate surgery. Operational access is possible in three ways:

• behind the pubis,
• through the crotch area and
• by a minimally invasive laparoscopic prostatectomy approach.

In recent years, a fundamentally new technology has been developed. Laparoscopy with a small amplitude of movement of the instruments is being replaced by a new technique - robotic-assisted operations for removing the prostate with a da Vinci robot.

History of the creation of a medical robot

The idea of creating a robot that could operate at a distance from the surgeon dates back to the 80s. XX century. Then, during military clashes, American scientists came up with the idea to completely exclude surgeons from the field of hostilities, instead developing robots for the army that could perform complex operations. Today's Da Vinci robot is used only in clinical settings, and the doctor is in close proximity to the patient.

The device got its name in honor of the great scientist and artist of the 15th-16th centuries, since the first drawing of a human robot in history was discovered in the manuscripts of Leonardo da Vinci. The technology of the Da Vinci Robot is also applied:

More than 300 installations are currently in use around the world. Robotic-assisted laparoscopic prostatectomy allows you to perform a radical operation to remove the prostate, sparing the surrounding tissues as much as possible, with minimal blood loss and high chances of maintaining erectile function and urinary retention. It can be said that the Da Vinci robot in the diagnosis of prostate cancer combines the advantages of open access with good visibility and laparoscopy with minimal blood loss and a low complication rate.

The first operation to remove the prostate using a Da Vinci robot was performed in September 2002. By 2008, 77% of radical prostatectomies in the United States were performed using this technology, 2% by classical laparoscopic prostatectomy, and about 20% by open access. In 2006, only a few specialized centers worked with this technology in Germany, but in recent years the method has been spreading more and more.

Prostate removal by da vinci robot cybernetic precision

Modern development of technology has allowed the operation of laparoscopic prostatectomy to be performed with the help of a robot as an assistant. This does not mean that the robot simply feeds the scalpel. In fact, the robot assistant becomes the eyes and hands of a surgeon, but only with more advanced capabilities than human ones! Removal of the prostate by the Da Vinci robot takes place through the control of a person at a distance. The surgeon operator sits at the control panel and works with special levers for each hand and foot pedals.

These movements are recognized by sensors and transmitted to a computer, from where they reach the instruments located directly in the area of the surgical field via special cables. Next to the patient in the sterile area is a surgical assistant. The robot's arsenal contains many surgical instruments, as well as optical devices.

On the screen, the surgeon-operator sees a three-dimensional image of the surgical field enlarged up to 10 times. Three-dimensionality of the image is achieved due to the simultaneous operation of several parallel cameras. Scales for instruments - increase or decrease - further increase the accuracy of manipulations. In addition, the robot has a special filter that suppresses the shaking of the human hand.

Another advantage of the technique is greater freedom of movement compared to conventional laparoscopic prostatectomy: the device, like the joint of the human hand, has 7 degrees of freedom of movement, while the laparoscopic prostatectomy instrument has only 3. Due to the comfortable position, the surgeon can perform operations with better concentration and less fatigue.

• transperitoneally (through the abdomen) or
• extraperitoneally (bypassing the abdominal cavity).

With extraperitoneal access, the frequency of bacterial complications and the likelihood of intestinal paralysis are significantly reduced. With this access, the field of operation is no less visible, and the usual removal of lymph nodes in such cases is performed without great difficulties.

21st century robotic laparoscopic prostatectomy

During the operation to remove the prostate, the patient is in the Trendlenburg position, that is, lying on his back with his head down at an angle of 10-15. A urinary catheter is inserted, which is usually removed on the seventh to tenth day after the operation.

The skin above the navel is dissected by five small incisions (6-11 mm), through which special dilators - trocars - are inserted.Only after that, the instruments of the da Vinci robot are introduced into the surgical field. With the help of them, the prostate gland is freed from ligaments, fatty tissue, blood vessels and surrounding organs. To improve visibility, carbon dioxide is injected into the cavity, with the help of which an artificial "preperitoneal" space is created.

First, the peritoneum is separated from the anterior abdominal wall, and the lymph nodes of the small pelvis are removed (if necessary according to the stage of the disease: cancer or prostate adenoma).

An important step is the isolation and ligation of the venous plexus, the so-called plexus of Santorini.

After the gland is released from the surrounding tissues, the transition to the bladder is identified using a previously inserted urinary catheter. The seminal vesicles and vas deferens are then gently released. The most painstaking stage of work is coming - it is important not to damage the finest cavernous nerves, nn. cavernosi, responsible for erectile function, and the external sphincter of the bladder. During the operation, small areas of the removed tissue are analyzed under a microscope, so it can be concluded that the tumor has been completely removed.

The bladder is connected to the urethra by an anastomosis. The prostate gland is removed at the end of the operation through the paraumbilical opening. Small wounds after trocars are usually sutured with absorbable suture material.

On the first day after the removal of the prostate by the Da Vinci robot, it is allowed to get up, the patient receives a light meal.

After 6-7 days after the operation, the tightness of the anastomosis between the bladder and the urethra is checked. For this purpose, an x-ray with a contrast agent is performed. In about 87% of patients, the catheter can be removed, in other situations it is necessary to leave it for a while.

The complication rate is very low, the most frequent are hematomas and failure of surgical sutures, although their size is much smaller than in conventional surgery. After the operation, the patient usually recovers quickly and can return to normal life after a short time. The ability to hold urine is restored in 95% of patients.

FIRST RESULTS

In 2006, the authors of the method published a review combining the first experience of using the da Vinci robot for 2001-2005. (-Die extraperitoneale radikale DaVinci-Prostatektomie- John H., Schmid D.M., Fehr J.-L. J. Urol. Urogynkol. 2006; 13 (4): 7-10). According to this review, operative time averages 180 minutes (140-295) and blood loss averages 300 ml (40-1100).

In a nutshell, the benefits of Laparoscopic Da Vinci Robotic Prostatectomy for the patient can be summarized as follows:

• less pain,
• less blood loss,
• less chance of infectious complications,
• more likely to maintain potency and urinary retention,
• precision of manipulation, small scars,
• quick recovery after surgery.

Robot or laparoscopy?

With the introduction of the robot in surgery for the treatment of prostate cancer, the operating doctors, of course, had a question: what is better for whom? Standard laparoscopic prostate surgery or da Vinci robotic surgery. Both methods are minimally invasive, and there is little blood loss.

Therefore, if both methods are possible, surgeons often face a dilemma - which one to choose? After all, in the end, the results of operations with laparoscopic and robotic prostate removal are often the same in their success if an experienced surgeon operates.

And here science comes to the rescue. In 2015, five leading urological clinics in Germany, where the Da Vinci Robot is used, teamed up to conduct a major clinical trial. With its help, they want to get an answer to the question - in what cases is it more effective to use the da Vinci robot for the treatment of prostate cancer, and in which laparoscopic technique?

During the study, indicators such as patient satisfaction with the operation, preservation of urination function, quality of life and preservation of potency will be taken into account.

For 3 years, doctors will monitor 780 patients who have been treated for prostate cancer using a da Vinci robot or a laparoscopic unit.

The initiator of the study is the University Hospital of Leipzig. He also has connected Urological University Centers from Düsseldorf and Heidelberg. In addition, patients are monitored at the Academic Clinical Center Dortmund. Doctors expect to present the final results in 2020. Interim - in 2018. "Until now, there have been no such studies on the long-term effect, says Dr. Sigrun Holze, head of the research project at the University Hospital Leipzig. Our study will change this."

C.M.S. othersSofia Rothermel

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Da Vinci prostatectomy Robotic removal of prostate cancer

The operation helps maintain potency and normal urination

Robot prostatectomy is especially effective in the early stages of the cancer process: PSA 20 ng / ml, Gleason 7. If the patient has no contraindications to anesthesia due to concomitant diseases.

Sexual function is restored within a few months, but in some cases within a year depends on the physical characteristics of the patient and the size of the tumor. In men under 50 years old, the probability of maintaining potency is more than 90 percent, up to 60 years old - 75 percent, up to 70 years old - 57 percent, over 70 years old - 25-50 percent.

Guarantee of normal urinary continence immediately after surgery 97%

Involuntary leakage of urine after conventional surgery occurs in 85% of patients and can last up to 9 months. This is an extremely unpleasant side effect of prostate cancer treatment, since you have to wear urological pads or diapers. When coughing, running, or exertion, urine leakage can persist for a lifetime of stress urinary incontinence.

Urinary incontinence occurs due to dissection of the ligamentous apparatus of the small pelvis. Such a dissection is necessary to gain access to the dorsal venous complex covering the prostate. It is bandaged or stitched with a surgical thread to avoid powerful bleeding in case of damage.

Fascia - and the nerve-sparing method that we use, allows you not to touch the dorsal venous complex. The doctor carefully displaces the fascia and ligaments, makes a 2x3 cm "window" in the pubovesical ligaments, and exfoliates the prostate. Then it "closes the window" by sewing together the fragments of the bundles.

Bleeding insurance is provided by a robotic system, it allows you to quickly change the intra-abdominal pressure and stop the bleeding, if necessary.

Da Vinci operation has advantages over other techniques

The main disease goes away immediately. Alternative ablative technologies (ultrasound ablation, nano-knife, cryoablation) do not guarantee the complete destruction of tumor cells.

After unsuccessful ablative surgery, it is much more difficult to perform a salvage (salvage) prostatectomy.

Neurosparing prostatectomy with fascia preservation eliminates damage to the pelvic floor muscles with pudendal nerve branches located in them and (or) an additional pudendal artery that feeds the cavernous tissues of the penis. This means that potency is more likely to be preserved than traditional or nerve-sparing surgery without fascia preservation.

Robot operation provides precision unattainable by other methods

It is possible to penetrate into all hard-to-reach places. Manipulators rotate in any planes by 360 degrees. A 10x 3D image helps you see perfectly in the depth of the surgical wound. Electronics filters out unpredictable movements and tremors of the human hand.

The doctor sees the operating field on the monitor and controls the robot through the joystick. One robotic arm holds the video camera, while the other three perform tissue manipulations.

The prostate is separated and evacuated with an endoscopic instrument smaller than a pencil in diameter. The bladder is then sutured to the urethra. The operation time is a little over two hours. They are discharged after 2-3 days, physical activity is allowed two to three weeks after the operation.

During prostatectomy, the robot uses laparoscopic access, compared to open surgery, it has the following advantages:

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Prostate adenoma treatment by da Vinci robot

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DA VINCI ROBOT SURGEON - PROSTATE ADENOMA

DA VINCI ROBOT SURGEON is an innovative technology in the field of minimally invasive surgery.

Da Vinci surgical robot allows you to effectively perform operations in various areas of medicine.

Among them: gynecology, urology, cardiac surgery, gastroenterology, oncological surgery and other areas of surgery that require minimal intervention and the most accurate actions.

The Da Vinci robot is used in many areas of medicine, including urology.

PROSTATE ADENOMA (benign prostatic hyperplasia) is a benign neoplasm that develops from the glandular epithelium or the stromal component of the prostate.

Prostate adenoma is a common disease in which the prostate gland enlarges.

Adenoma is diagnosed in every second man over the age of 50.It has nothing to do with prostate cancer and is benign.

With prostate adenoma, the growth of the prostate's own glandular tissue occurs. By itself, the adenoma is safe, it does not metastasize and does not grow into other internal organs, like cancer. However, as it grows, it can cause difficulty urinating, and in advanced stages even chronic renal failure, which seriously threatens the life and health of the patient. In addition, it is possible for a benign adenoma to degenerate into prostate cancer.

The adenoma develops slowly and gradually compresses the urethra, disrupting the process of urination. There is a stretching of the bladder, the outflow of urine from it is difficult.

CAUSES AND RISK FACTORS OF BODY PROSTATE

The causes of prostate adenoma are still unknown to modern medicine.

The risk of getting PROSTATE ADENOMA increases after 40-50 years. In young men, this disease is extremely rare.

There are several risk factors for this disease:

Aging. Every second man after 50 years of age is diagnosed with Prostate adenoma.

Heredity. If an adenoma is found in close relatives of a man, he is highly likely to get sick too.

Hormonal imbalance in the body.

Nationality. White and black men are more likely to suffer from this disease than Asians.

SYMPTOMS OF BODY PROSTATE

Symptoms appear only in 50% of patients, the rest are asymptomatic.

Some symptoms of BPH

The urine stream becomes sluggish and intermittent

Feeling of incomplete bladder emptying

Frequent urge to urinate

Delayed start of urination

Feeling full bladder

For complete emptying of the bladder, tension of the abdominal muscles is necessary

Partial or total Urinary incontinence. Urgency of the urge to urinate.

The need to wake up several times during the night to go to the bathroom

Pain in the lower abdomen and perineum

The following symptoms may indicate the presence of complications:

Hematuria (blood in the urine)

Acute urinary retention. Acute urinary retention causes a sensation of pain in the bladder. In this condition, you should immediately consult a doctor.

Infectious process in the urinary tract. May be accompanied by fever, frequent urination, pain and burning during urination.

DIAGNOSIS OF PROSTATE ADENOMA

Methods for diagnosing prostate adenoma

Survey of the patient (collection of anamnesis). The age of the patient is fixed, the doctor specifies the nature of his complaints (clinical manifestations of the disease, the dynamics of their development).

Digital transrectal examination of the prostate. With the help of a digital examination, it is possible to conduct a differential diagnosis of prostate adenoma and prostate cancer.

Ultrasound examination of the prostate. Allows you to accurately determine the location and size of the tumor.

Excretory urography. It is carried out to assess the functional state of the kidneys and the patency of the urinary tract.

Complete blood count and blood test to determine the level of prostate-specific antigen (PSA).

TREATMENT OF PROSTATE ADENOMA

Prostate adenoma is treated conservatively (medication) and surgically.

At the early stage of the disease, various medicines are used. In the later stages and with the development of complications, surgical intervention may be required.

The most effective method of treating prostate adenoma is surgical. There are several types of operations that are performed for adenoma. The type of operation performed is determined by the doctor.

Robotic technique allows you to perform the operation more accurately, without hitting the delicate nerve plexuses around the prostate gland, which are responsible for the potency and functioning of the bladder.

The Da Vinci robot is an ultra-modern surgical system that allows you to perform operations that are inaccessible to the capabilities of the human hand.

The da Vinci robot has a camera that shows a high-resolution 3D image of the operated area and miniature surgical instruments that allow you to achieve excellent results when working with human body tissues.

Robotic surgery has many advantages over traditional technologies:

Firstly, when removing prostate adenoma with a da Vinci robot, the risk of damage to the nerves responsible for erection is much lower.

Normal urination is restored faster.

Less risk of postoperative complications.

Blood loss during surgery below.

The hospital stay is shorter, the patient recovers faster, the recovery period is easier.

The patient has to wear a catheter for fewer days

Small incisions in the abdominal wall heal faster.

Surgery with the help of the Da Vinci Robot (daVinci) is the most progressive surgical treatment.

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