Prostate cancer operation with da Vinci apparatus

Prostate Cancer - Why Da Vinci Surgery?

PROSTATE CANCER IS A DISEASE IN WHICH MALIGNANT (CANCER) CELLS FORM IN THE PROSTATE TISSUES.

The prostate produces a fluid that is a component of semen.

According to WHO expert estimates, about 400 thousand cases of this disease occur annually in the world. In Europe, in the structure of male mortality from malignant neoplasms, Prostate cancer ranks second after lung cancer. The true prevalence of pathology is much higher than officially registered. Over the course of a lifetime, prostate cancer is diagnosed in 1 out of 6 men.

The chance of recovery is higher, and mortality is lower if the cancer is detected at an early stage, which is why public awareness of PROSTATE CANCER and timely diagnosis are so important. New advances in the field of medicine allow patients with prostate cancer to return to a full, active life after treatment.

Symptoms

In the early stages, prostate cancer may be asymptomatic. A doctor can detect signs of prostate cancer during regular PSA (Prostate Specific Antigen) and/or DRE (Digital Rectal Examination) tests.

The PSA blood test is the first prostate-specific antigen (PSA) blood test. Thanks to the PSA test, it is often possible to detect prostate cancer at an early stage. PSA levels can be high not only among men with prostate cancer, but also in men with an enlarged thyroid and prostate infections. However, a PSA test alone won't always tell you if you have cancer.

When symptoms appear, they may include:

• frequent urination (especially at night);
• difficulty urinating;
• problem starting or holding back urination;
• weak or intermittent urine flow;
• soreness or burning when urinating;
• blood in urine or semen;
• painful ejaculation;
• Frequent pain in the lower back, hips, or upper thighs.

Causes and risk factors

The causes of prostate cancer, like other types of cancer, are not fully understood. There is no consensus on what causes prostate cancer. However, there are certain factors that are associated with an increased risk of developing prostate cancer.

Age and genetics

Prostate cancer is quite rare in men under 50 years of age, after this age the likelihood of developing the disease increases. By age 80, more than half of all men will have some form of cancer that may not require treatment. Prostate cancer may be an inherited genetic factor. If your father or brother had prostate cancer, your risk of developing this disease doubles. The risk is higher if several of your relatives have had prostate cancer, especially if the relatives were young at the time of diagnosis.

Diet and lifestyle

Lifestyle, diet, and exposure to environmental toxins play a role in the development and rate of progression of prostate cancer. A diet high in red meat, calcium (dairy) and bad cholesterol (LDL) significantly increases the risk of disease. Improper diet, obesity and lack of exercise can lead to the development of prostate cancer. Men with a body mass index (BMI) of 32.5 and above are 30% more likely to die from prostate cancer, and men with a BMI of 35 are 60% more likely to have prostate cancer recurrence within 3 years. Help prevent prostate cancer diets rich in raw foods and vegetables, foods rich in omega-3 and 6 fatty acids, and foods high in antioxidants. In addition, selenium, vitamin D, and vitamin E supplements are helpful in preventing prostate cancer, as they help lower PSA levels and suppress tumor growth.

Prostate cancer growth

In more than 99% of cases, prostate cancer develops from glandular cells. Glandular cells produce seminal fluid, which is secreted by the prostate. The medical term for cancer that begins in glandular cells is adenocarcinoma. Most diseases grow very slowly. Pathological studies show that many older men who died from other diseases also suffered from prostate cancer, but neither they nor their doctors knew about it. However, there are cases where cancer can grow and spread very quickly. Even now, with the current level of development of medicine, it is difficult to say which types of cancer can be life-threatening and which will not require treatment.

Changes in prostate cells

Some doctors believe that prostate cancer begins with a condition called prostatic intraepithelial neoplasia (PIN). PIN begins to appear in men over the age of 20. By the age of 50, almost 50% of men have PTS.In this condition, there are microscopic changes (size, shape, etc.) of prostate cells. These changes are either low grade (cells appear almost normal) or high grade (cells look abnormal). If you have been diagnosed with high-grade PIN by prostate biopsy, there is a 30 to 50% chance that the cancer is within the prostate. Men diagnosed with high-grade PIN are closely monitored and periodically biopsied by the prostate.

Prostate cancer screening and testing

Digital rectal examination (DRE)

During PID, a doctor or nurse manually palpates the prostate through the rectum.

Prostate-specific antigen (PSA) test

This test measures the level of PSA in the blood. PSA levels can be high in men who have prostate cancer, infection, inflammation of the prostate, or benign prostatic hyperplasia (enlarged prostate). To get a more accurate picture, doctors usually use a combination of PRI and PSA test.

Transrectal ultrasound (TRUS)

TRUS uses sound waves to create an image on the screen. A probe that emits ultrasonic waves is placed in the rectum; reaching the prostate, ultrasound waves create an echo that collects the probe. The computer processes the structure of the echoes into an image of the prostate. The procedure takes only a few minutes.

Biopsy

A biopsy is a procedure in which a sample of a patient's tissue is examined under a microscope. Under the control of TRUS, the doctor inserts a thin needle through the wall of the rectum into the patient's prostate. A cylinder of tissue is then removed from the needle (typically 1/2 inch long and 1/16 inch diameter) and sent to a laboratory for cancer testing.

Methods of treatment

There are the following methods of surgical treatment of prostate cancer:

• open surgery;
• laparoscopic surgery;
• da Vinci robot-assisted surgery

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. Dr. Sophia Rotermel

Find out the cost of treatment and diagnostics.

Prostate cancer treatment. Questions

Dear patients! On this page we publish your questions regarding prostate cancer treatment in Germany. Send us questions by email. mail or the "ask a question" form on the site.

We publish the most frequently asked questions about prostate cancer and cancer treatment in Germany here. Also, in the question, indicate your age, stage of prostate cancer, Glisson score and current PSA value. The answers will be more accurate.

1. I am 62 years old, I am not sick with anything, a month ago I did a prostate biopsy and was diagnosed with stage 1 prostate cancer. I want to go to Germany for treatment. What method do you recommend?

In your case, it is possible to remove the prostate with the Da Vinci Robot. If you have a visa to Germany, admission to our clinic is possible within a few days.

2. My father is 87 years old. He has stage 2 prostate cancer, PSA 11 ng, Glisson 4+3. He himself wants to undergo treatment in Germany. Should I go for treatment?

For patients with a life expectancy of less than 10 years, we would recommend hormone therapy, radiation therapy, or alternatively brachytherapy. The question of prostatectomy surgery, given the age, is not worth it.

3. A diagnosis of T2N0M0 prostate cancer was made. I want to have a prostate removal operation in Germany. But I have asthma. Can I have surgery using the Da Vinci Robot?

In your case, we suggest performing laparoscopic prostatectomy in a classic minimally invasive way. Bronchial asthma is a contraindication and the Da Vinci Robot is not used in this case.

4. My age is 49 years old, during the last 2 years PSA has been rising. Three months ago I had a PSA of 4.5 now 6.7 ng. Nothing was found. I'm worried about the further rise in PSA. What do you recommend?

We recommend repeating the PSA test and biopsy in two months. With a further increase in PSA, a biopsy is required under the control of MRI and at least 18 points. Such a biopsy is performed in our clinic, if possible, come to Germany for treatment.

5. How quickly should the prostate be removed for prostate cancer? I was diagnosed yesterday, I am 58 years old. Healthy.

Depends on the degree of malignancy of prostate cancer, it is determined by the Glisson scale. In general, prostate cancer is classified as a slowly growing tumor, you can take your time to make a decision and undergo surgery within 2 months, if possible in Germany.

6. What do you recommend brachytherapy or prostatectomy? Prostate cancer. 63 years old. There are no other diseases.PSA is now 11.3 ng, Glisson is 3+36

We recommend removing the prostate by prostatectomy using the Da Vinci Robot. 8 days in the hospital. Minimum complications and side effects. Brachytherapy is considered only in the second place.

7. I was diagnosed with prostate cancer. Have made a scintigraphy on which single metastases in bones of a basin. I'm still young, I'm 58 years old, how to live and be treated further?

We also recommend a choline PET CT scan to determine the exact location and extent of the metastasis. Talk to your doctor, we would recommend hormone therapy and radiation therapy.

8. Do I need an MRI if I suspect prostate cancer? The queue is only in 2 weeks for this study, I have a visa, I am ready to leave for treatment in Germany. Your advice.

It is much more important to do a scintigraphy. If you have a visa to Germany - come, we will do everything in a couple of days. Then at the oncology conference we will decide how to treat prostate cancer in your case.

9. Tell me, if you do not treat prostate cancer, well, that is, do nothing at all. How long will I live? Was diagnosed with prostate cancer. I think this is a mistake, because I feel great, nothing hurts, I go in for sports.

Prostate cancer is an insidious disease manifested in the complete absence of symptoms in the early stages. You are most likely in this stage. The early stage of prostate cancer is subject to treatment, a complete cure is possible, it is important not to miss the time. If prostate cancer is not treated, then depending on the type of malignancy (see Gleason Index), the development of bone metastases, bone destruction, fractures, and if it is the spine - paralysis, then metastases appear in the organs leading to the failure of their function and death.

10. I want to go and have prostate cancer treatment in Germany. Age 64, PSA today 8.9, biopsy two months ago, Glisson score 3+47. Recommend the treatment center on the Da Vinci Robot.

We recommend the Prostate Center Dortmund. The clinic has everything you need for the treatment of prostate cancer of any complexity. This is a large multidisciplinary university center. The head of the clinic, Professor Truss, is one of the best European urologists. The clinic also has a Da Vinci Robot. The waiting time for the operation from the application to the departure is several days.

11. How can I prevent the development of prostate cancer in myself? I'm 45 years old. My father had prostate cancer. I don't want to get sick too.

Unfortunately, no one is immune from the diagnosis of prostate cancer. It is impossible to prevent it, but to identify it in the early stages in order to carry out treatment in time is within your power. Until the age of 50, have your PSA checked annually. After 50, an annual examination by a urologist is recommended. If the PSA level continues to rise, it is necessary to visit a urologist earlier. So you can identify cancer and completely recover from this insidious disease.

12. During a scheduled medical examination, PSA in the blood was set to 4.2 ng, my age is 55 years old, what do doctors in Germany recommend in my case?

Pass the test again in a couple of weeks. Go to the urologist for a consultation. If possible, come to us in Germany for examination.

13. I have been diagnosed with prostate cancer. Diagnosed a week ago. Recommend removal of the prostate. In addition, I am on dialysis (artificial kidney machine). I need dialysis 3 times a week. Are there any contraindications for prostate surgery?

In Germany, being on dialysis is not a contraindication to prostatectomy surgery. The prostate center in Dortmund has an artificial kidney department where you can carry out the necessary procedures. Send me the protocol of dialysis to organize not only the operation, but also sessions on the artificial kidney machine.

For prostate cancer treatment in Germany, please contact:

Prostate Center Dortmund