The Goals of Robotic Prostate Cancer Surgery

What are the goals of robotic prostate cancer surgery?

147461664Surgeons have a number of goals they strive to achieve during robotic prostate cancer surgery. Removing all the diseased tissue and curing the patient is the primary goal. Negative margins are needed in order to ensure complete removal of all cancerous tissue and doctors are careful to preserve the neurovascular bundles.

The nerves that supply the penis for erection are carefully moved during robotic prostate cancer surgery to avoid damage. Doctors pay attention to the urethra and the size of the bladder opening as well. Dr. David Albala goes over what doctors try to achieve during robotic prostate cancer surgery.

David Albala, MD: There are a number of goals that we as robotic surgeons have when we go in to do a robotic surgery. First and foremost is curing the patient of their disease. Unfortunately, to the naked eye, prostate cancer looks very similar to normal tissue and when we do this surgery, you don’t see a great demarcation between cancer tissue and normal tissue, but the ultimate goal of robotic surgery is to get all the cancer out and have negative margins.

In patients that have more extensive disease, if we believe the disease is outside the prostate, as surgeons we can swing the margins a little wider to make sure that we get negative margins. In some ways, robotic surgeons’ eyes become their hands.

When we do open surgery, we are allowed to feel tumors that are palpable. With robotic surgery, you don’t have that sensation of being able to palpate things, so your eyes become your hands and are able to see where things are, if you see differences in tissue colors and size and so forth, you may want to swing a margin out little wider to ensure that you get a negative margin.

We would like to try to preserve the neurovascular bundles when we do the surgery. We know that the nerves that supply the penis for erection run alongside the prostate and we can peel those nerves off like peeling an onion skin off an onion and typically what we like to see is, we like to see two bundles after we have taken the prostate out in the prostatic bed to represent where those neurovascular bundles are. Now only do we believe that that is important for erectile dysfunction and erectile function going forward but there may be some link to incontinence.

We would like to see a nice stump of the urethra and the nice small opening of the bladder neck and those are important because I think those help with urinary continence. So as a surgeon, what we like to do is, one, make sure that we cure the cancer, two, we would like to see some anatomical landmarks of where we know those nerves are and three, we would like to see a good long stump and a very small bladder neck to sew things back together because we believe that all those factors may have some impact on urinary continence in patients going forward.

Dr. David Albala
Dr. David M. Albala is Chief of Urology at Crouse Hospital in Syracuse, New York and Medical Director for Associated Medical Professionals. He is considered a national and international authority in laparoscopic and robotic urological surgery and has been an active teacher in this area for over 20 years.

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