Prostate cancer surgery using a robot

Prostate cancer surgery using a robot

PROSTATE CANCER - ROBOTIC PROSTATECTOMY Robotic prostatectomy is the latest technology for minimally invasive interventions for prostate cancer using 3D imaging and special robotic tools to remove the cancerous prostate. In general, the main advantage of robotic prostatectomy is the short recovery period after surgery compared to traditional prostatectomy.

Modern medicine, and especially oncourology, today offers the latest advances in the treatment of prostate cancer. If earlier the prostate affected by cancer was removed using a large incision in the lower abdomen or in the perineum, now it is enough to make several small mini-incisions using endoscopic techniques.

Using a special surgical panel and a high-quality imaging system, the surgeon removes the entire prostate and surrounding lymph nodes through these mini-incisions. Like other laparoscopic interventions, robotic prostatectomy is performed through several (4-5) small puncture incisions no larger than 1 cm. This results in much less blood loss, a shorter postoperative period and faster recovery compared to conventional prostatectomy.

Robotic prostatectomy allows the doctor to achieve filigree work with tissues. Currently, the most well-known system for robotic prostatectomy is the Da Vinci system. This system allows the doctor to operate so delicately that it is possible to preserve the blood vessels and nerves responsible for potency.

The operating surgeon is not forced to stand in an uncomfortable position near the operating table, that is, the fatigue of the surgeon is minimal, and, therefore, the “jewelry” of the operation is also better. It is worth noting that one should not be afraid that the robot may do something wrong during the operation. The robot is completely under the control of the surgeon and performs all his manipulations exactly.

Another difference from the simple laparoscopic operation of the da Vinci method is that it uses not simple instruments, but smaller ones and having up to 7 degrees of freedom, which allows the surgeon to move them in different directions.

Laparoscopic radical prostatectomy using the daVinci Robot is the latest in technology and medicine in the treatment of PROSTATE CANCER. The use of this technique will not only improve the radical treatment of prostate cancer, but will also improve the quality of life of the patient due to the minimum number of complications and the length of stay in the hospital.

One of the main advantages of the Da Vinci method is, as already indicated at the beginning, the minimum of complications.

Less than 1% of bowel dysfunction,

Less than 1% of intestinal wounds requiring a colostomy

Less than 1% of bladder and urethral injuries that require additional intervention.

Less than 1% of cases of urine leakage through the applied connection, which requires long-term catheter wear and long hospital stay.

Less than 1% bleeding, bruising, and needing a blood transfusion.

Less than 1% wound infection or herniation.

Less than 3% of the formations of strictures (narrowing) of the urethra.

Less than 5% of cases of Urinary incontinence one year after surgery.

As with open and laparoscopic prostatectomy, robotic prostatectomy is indicated for patients with localized prostate cancer. During robotic prostatectomy, the surgeon's arm is replaced by a robotic arm. With the help of two-handed control, the exact movements of the surgeon are transferred to the robot and all this is controlled on the monitor screen. One manipulator is equipped with a high-quality video camera, and the other with miniature surgical instruments.

When can robotic prostatectomy be used?

When determining whether a patient is suitable for robotic prostatectomy, the clinician must consider many factors to make the right decision.

What are these factors?

Firstly, this is the stage of cancer. Robotic prostatectomy, like open prostatectomy or laparoscopic prostatectomy, is done only for localized prostate cancer. In addition, like all other surgical interventions for prostate cancer, certain complications are also characteristic of robotic prostatectomy, such as impotence and urinary incontinence.

Therefore, when choosing this method of treatment, it is necessary to take into account the age of the patient and his life priorities and compare them with possible complications, carefully weighing all these factors. In addition, the choice of this method of treatment may be influenced by the general condition of the patient, surgery and some other features.

In short, the goal of a partial or radical prostatectomy is to completely remove the cancerous tissue in and around the prostate. Therefore, for patients with a prostate cancer stage higher than T2 (that is, when the cancer has already spread beyond the prostate), robotic prostatectomy is not suitable, since in this case the removal of the prostate and the surrounding lymph nodes will have little effect on tumor progression.

Identification of the stage of prostate cancer to resolve the issue of the possibility of robotic prostatectomy is carried out using such research methods as CT, MRI, radiography. However, it is worth noting that imaging alone is not sufficient for staging prostate cancer. Early diagnosis of prostate cancer is very important, as at this stage, robotic prostatectomy allows you to perform an operation while preserving nerves and blood vessels.

Localized prostate cancer is usually characterized by a non-aggressive course, does not threaten the patient's life and does not affect his general condition. For this reason, surgeons take into account the age of the patient when determining the possibility of using robotic prostatectomy.

In general, if the so-called survival period of a patient averages no more than 10 years, then the risk of complications of robotic prostatectomy outweighs the effect of the operation. In addition, the surgeon must take into account the general condition of the patient in order to know whether the patient can cope with the disadvantages of surgery.

Surgical interventions on the part of the abdominal organs are also important. Patients with a body mass index of more than 30% and those who have undergone abdominal interventions are characterized by a longer duration of the operation, more blood loss and a higher risk of complications.

The outcome of robotic prostatectomy is directly related to the experience of the surgeon and this procedure should only be performed by a specialist who is skilled in this operation.

How is robotic prostatectomy performed?

The day before the operation, the patient must prepare the intestines. This is a cleansing enema. On the eve of the evening, the patient should not eat.

In this operation, the surgeon performs an excision, that is, the removal of the prostate and lymph nodes around it. Its difference from the traditional operation is that access to the prostate is carried out through several small incisions. This allows you to reduce trauma to the body, reduce bleeding during surgery and discharge the patient home faster.

The operation itself is performed with the patient lying down with the pelvis elevated (the so-called Trendelenburg position). The operation is performed under general anesthesia or epidural anesthesia. Carbon dioxide is injected into the patient's abdominal cavity through a mini-incision to create space so that manipulations can be performed

The whole operation takes on average 2 to 4 hours, and the recovery period is on average one day.

Stages of laparoscopic robotic prostatectomy

Systems for robotic laparoscopic prostatectomy, like the Da Vinci system, have three or four manipulators, one of which is equipped with a video camera that allows the surgeon to see the entire operation in real time. The other two manipulators are equipped with tools that mimic the movements of the surgeon, allowing you to achieve precise and accurate movements, including resection, clipping, dissection, and others.

After all the necessary instruments have been inserted into the patient's abdominal cavity, the surgeon performs the operation while sitting at a special console. The surgeon's assistants help him throughout the operation, draining the surgical field from blood.

Using the manipulators of the surgical control panel, the doctor makes an incision in the peritoneum. To stop bleeding, suturing or clipping or coagulation is used.

Next, the surgeon separates the prostate gland from the bladder. If the cancer is limited to the prostate tissue, the doctor performs nerve-sparing surgery in the prostate area. To do this, he carefully separates the neurovascular bundle from the surrounding tissues.

This is a very delicate manipulation. It is achieved thanks to the most precise movements of the manipulators and the magnification of the image of the surgical field. After that, the lymph nodes surrounding the prostate are removed and the bladder is sutured to the urethra. In this case, the surgeon tries to minimize damage to the muscles surrounding the urethra for faster recovery of urination in the postoperative period.

Recovery after robotic prostatectomy Patients are usually allowed to walk by the evening of the operation and are discharged home the next day. The urethral catheter, which remains after the operation, is removed, as a rule, on the 4th-7th day. After 1-2 weeks, the patient can return to their normal work. It is recommended to avoid strenuous physical activity for 4 weeks.

Because robotic laparoscopic prostatectomy is a minimally invasive procedure, pain during the recovery period is moderate to mild and requires minimal pain medication. For some time, patients may experience urinary incontinence, which over time, usually stops within a month.

Restoration of sexual activity usually depends on the ability of the surgeon to preserve the nerve bundle during the operation. If prostate cancer affected only the gland itself, and the surgeon was able to perform the operation while preserving the nerves responsible for erectile function, sexual activity can be fully restored after 1-3 years. The results depend on many factors, including the patient's emotional state, age and libido.

Possible complications of robotic prostatectomy

No surgical intervention is without the risk of complications and side effects.

Despite its low invasiveness, this operation has the same risks of complications as conventional prostatectomy. The likelihood of complications depends on many factors: the age of the patient, the general health of the patient, the stage of prostate cancer, and the experience of the surgeon performing the operation. In general, clinical studies show that the result of robotic prostatectomy is equivalent to conventional prostatectomy, and the risk of complications is lower.

Despite the fact that robotic prostatectomy is a minimally invasive procedure, certain complications can occur. The first is bleeding. Since the prostate itself is surrounded by blood vessels in the tissues, bleeding can occur both during and after surgery.

Robot-assisted prostatectomy has a lower bleeding risk than traditional prostatectomy. Other complications can be deep vein thrombosis and postoperative hernia at the incision site. The risk of these complications is very small.

Urinary incontinence and impotence after robotic prostatectomy

Due to the special localization of the prostate, urinary incontinence and erectile dysfunction (impotence) may also occur after this operation. For some period after surgery, patients may experience urinary incontinence. The fact is that two muscles are responsible for the act of urination, one of which is closely adjacent to the prostate. After the operation, the ability to urinate normally is restored over time, as the muscles strengthen.

One of the important points after prostatectomy surgery is the possibility of sexual activity. It all depends on the stage of cancer, whether the tumor affects the nerve bundle responsible for erection, and how early prostate cancer was detected, which is why early diagnosis is so important. When possible, the surgeon performs an operation to remove the prostate while preserving the nerve bundle. According to clinical studies, sexual activity after nerve-sparing robotic prostatectomy can be restored within 1-3 years.

Today, in Israel, breast cancer can be completely cured. According to the Israeli Ministry of Health, Israel currently has a 95% survival rate for this disease. This is the highest rate in the world

Today, the standard of care for clinically localized prostate cancer (i.e., limited to the prostate), and therefore curable, is either various surgical methods or radiation therapy methods (brachytherapy). The cost of diagnosing and treating prostate cancer in Germany will be from 15.000 to 17.000

This type of surgical treatment was developed by the American surgeon Frederick Moss and has been successfully used in Israel for the past 20 years. The definition and criteria for Mohs surgery were developed by the American College of Mohs Surgery (ACMS) in collaboration with the American Academy of Dermatology (AAD).

• Breast cancer
• Oncogynecology
• Lung cancer
• Prostate cancer Risk factors for prostate cancer
• Prostate cancer symptoms
• Classification of prostate cancer
• Prostate cancer diagnosis
• Prostate cancer digital rectal examination
• Prostate cancer - PSA testing
• Prostate cancer - ultrasound
• Prostate cancer - biopsy
• Prostate cancer MRI
• Prostate cancer - computed tomography (CT)
• Prostate cancer - cystoscopy
• Prostate cancer - genetic tests
• Prostate cancer - endolgin tests
• Prostate cancer treatment
• Prostate cancer: expectant management
• Prostate cancer - radical prostatectomy
• Prostate cancer - robotic prostatectomy
• Prostate cancer - complications of surgical treatment
• Prostate cancer - surgical treatment and survival
• Prostate cancer - cryosurgery
• Prostate Cancer - High Intensity Focused Ultrasound (HFU)
• Prostate cancer - lumpectomy
• Prostate cancer lymphadenectomy
• Prostate cancer - chemotherapy
• Prostate cancer - hormone therapy
• Prostate cancer - PSA levels during hormone therapy
• Prostate cancer - hormone therapy and diabetes
• Prostate cancer - radiotherapy
• Prostate cancer - targeted therapy
• Prostate cancer - experimental treatments
• Side effects of prostate cancer treatment
• Prostate cancer and fatigue
• Early stage prostate cancer
• Locally advanced prostate cancer
• Treatment of locally advanced prostate cancer
• Locally advanced prostate cancer - hormone therapy
• Locally advanced prostate cancer - surgical treatment
• Locally advanced prostate cancer cryosurgery
• Local advanced prostate cancer high-intensity focused ultrasound
• Metastatic prostate cancer
• Prostate cancer - bone metastases
• Recurrent prostate cancer
• Prevention of osteoporosis in prostate cancer
• Prevention of prostate cancer
• Prostate cancer vaccination
• Nutrition and prostate cancer
• Prostate cancer vitamins and minerals
• Prostate cancer - fruits and vegetables
• Prostate cancer - dishes from tomatoes in the diet of men
• Prostate cancer - meat and fat
• Prostate cancer - ginseng and flaxseed
• Prostate Cancer - Recommended Diet
• Prostate Cancer - Soy Diet
• Prostate cancer - low carbohydrate diet
• Prostate Cancer - Vegetarian Diet
• Prostate cancer treatment in Germany
• Prostate cancer treatment in Israel

Nano-knife cancer treatment

Nano-Knife is the latest technology for the radical treatment of pancreatic, liver, kidney, lung, prostate, metastases and cancer recurrence. The NanoKnife electrocutes soft tissue tumors, minimizing the risk of damage to nearby organs or blood vessels.

CyberKnife cancer treatment

The CyberKnife technology was developed by a group of doctors, physicists and engineers at Stanford University. This technique was approved by the FDA for the treatment of intracranial tumors in August 1999, and for tumors elsewhere in the body in August 2001. At the beginning of 2011 there were about 250 installations. The system is actively spreading around the world.

Proton therapy for cancer treatment

PROTON THERAPY radiosurgery of a proton beam or heavily charged particles. Freely moving protons are extracted from hydrogen atoms. For this, a special apparatus is used, which separates negatively charged electrons. The remaining positively charged particles are protons. In a particle accelerator (cyclotron), protons in a strong electromagnetic field are accelerated along a spiral trajectory to a huge speed equal to 60% of the speed of light 180,000 km/s.

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 minimally invasive laparoscopic prostatectomy access.

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.

Da Vinci robot in surgery

Da Vinci robotic surgery is an effective, low-traumatic and high-precision surgical intervention performed remotely on various organs: prostate, heart, kidneys, lungs, liver and stomach.

What is the Da Vinci Surgical System?

Robotic procedures are very popular due to the small number of contraindications and the minimal risk of complications.This is state-of-the-art technology that was originally developed by NASA for space emergency operations.

This surgical intervention is classified as closed surgery, since the integrity of the tissues is practically not violated. The doctor controls the system using special consoles. Instruments and a video system are located on the manipulators.

Medical centers that perform operations with the Da Vinci robot guarantee the following benefits:

• no bleeding, little blood loss;
• reduced chance of infection;
• use less anesthetic medications;
• short rehabilitation period;
• only 2-3 mini-incisions are made, which subsequently heal quickly;
• the required rate of stay in the hospital is only 2-4 days;
• minimal damage to tissue integrity;
• reducing the duration, and, accordingly, the load on the body;
• minor pain;
• quick rehabilitation and return to the normal rhythm of life.

Numerous positive results of the operation by the Da Vinci robotic surgeon confirm its effectiveness and safety for health. Innovative technology makes it possible to perform treatment in various areas of medicine: cardiac surgery, oncology, urology, gynecology, traumatology, neurosurgery, etc.

How does the operation go with the participation of the robot?

Robotic systems consist of several interconnected components: a set of control devices with special handles, manipulators that imitate the hands of a surgeon, and a three-dimensional high-quality image of the operated area, which is displayed on a computer monitor.

The machine repeats the natural movements of the fingers and wrists of a person in exactly the given proportions in the exact sequence. This allows you to adjust the range of motion of the Da Vinci robot, doing any procedure without direct contact with the patient.

Usually, three small incisions are made in the skin over the desired internal organ. Through them, surgical instruments and a video camera are inserted into the body cavity on automated guides. The Doctor is in another room with a console and a screen. Thanks to two powerful lenses, it receives a three-dimensional image from the camera, which gives an accurate picture of the state of the body's internal systems. The camera is controlled using the pedals. They adjust the scale of the picture, the viewing angle, are responsible for the approach and distance of the video camera. Mobility sensors are fixed on the surgeon's hands, transmitting impulses to the machine's manipulators.

The high efficiency of the performed surgical interventions is due to the greater accuracy and smoothness of the movements of the machine, which eliminates accidental twitching, stiffness, trembling and other natural human errors, and provides easier access.

Common types of robotic interventions

There are many types of operations that are performed by the Da Vinci robot:

• valve reconstruction;
• gastric bypass;
• re-implantation of the ureter;
• bladder resection;
• removal of the thymus (thymectomy) and prostate (prostatectomy);
• implantation of vertebral discs and other defects of the musculoskeletal system;
• cutting off the lung lobe (lobectomy);
• excision of malignant and benign tumors;
• esophagectomy;
• re-vascularization of the myocardium (restoration of normal vascular circulation of the heart);
• pyeloplasty (elimination of the narrowed area at the junction of the renal pelvis to the ureter);
• hysterectomy (cutting out the uterus);
• ablation of cardiac fibers (elimination of abnormal formations that disrupt the rhythm of the beat);
• removal of myomatous nodules from the body of the uterus (myomectomy);
• liver and pancreas surgery;
• kidney resection, cutting out part of it, radical nephrectomy;
• implantation of a pacemaker for biventricular synchronization restart.

Prostate cancer removal by Da Vinci

An example of the successful use of robotic equipment is the use of the Da Vinci robot in urology. Minimally invasive surgery in this area is becoming increasingly popular for malignant lesions of the prostate (radical prostatectomy), which is successfully performed using the Da Vinci robot. The advantage of this operation over laparoscopic surgery is the use of a 3D image of the operated area.

The function of the robot is to hold the video camera and surgical instruments, giving the operating urologist the opportunity to concentrate all his attention on the process, giving him freedom of action.

The robot, which exactly repeats the movements of a person who is at the control panel of the robotic surgical system, allows the surgeon to be in a comfortable position, minimizing his fatigue, making it possible to see the image in full, control instruments and perform the most meticulous surgical intervention, improving its quality.

A urologist during a prostatectomy has a unique opportunity to remove the prostate gland with seminal vesicles without affecting the healthy muscles and nerves in the pelvic floor. This operation reduces the risk of developing sexual dysfunction and problems with urinary and fecal incontinence. In 95% of cases, the removal of the prostate using the Da Vinci robot is successful, and the operated area remains "free of the tumor".