Robotic surgery for urological cancers

The Urology Practice now offers robotic surgery for prostate, bladder and kidney cancer patients. The experienced surgeons at The Urology Practice are among only a handful of urologists credentialed to operate the new, da Vinci robot at Hurstville Private, which is the only hospital advanced to have this technology in Sydney’s South.

The Urology Practice’s surgeons have completed approved robotic training programs in the United States.

The latest studies suggest in experienced robotic surgery units, with well trained experienced surgeons appropriately selected prostate cancer patients may benefit from:

• Less blood loss and lower transfusion rates;
• shorter hospital stay;
• less pain;
• earlier return of urinary continence and erectile function;
• lower risk of wound infection and scarring
• faster recovery and return to work.

Kidney and bladder cancer patients experience similar benefits.

Surgeons enjoy increased precision and visualisation of the procedure, with cameras inside the body providing magnification nine times greater than what the naked eye can see.

 

Is Robotic Assisted or Open Surgery the best approach?

This is a very important question many patients struggle with and there is much mis-information in the literature. Open surgery has long term results and has been proven safe and effective over 4 decades. Robotic assisted surgery has been in common use for less than a decade with initial reports which were very concerning to our experienced and well trained surgeons.

Recent reports suggested a four and a half fold higher dissatisfaction rate (and higher regret of treatment choice) with the robotic approach (Schroek et al, Eur. Urol. 2008). Concerns were raised about the cure rates with robotic surgery in 2008 when a very good cancer journal published a 4 times higher risk of requiring salvage radiation therapy for incomplete cancer removal (Hu et al. JCO 2008). In 2009, a report in JAMA, one of the best scientific journals in the world, suggested higher rates of urinary incontinence and erectile dysfunction with the robotic approach (Hu, JAMA Oct. 2009). As recently as last year (2012), a report again suggested poorer urinary continence with robotic surgery when compared to open surgery (Barry et al JCO 2012).

Several studies have suggested no difference in time to recovery or discharge from hospital.

Our experienced surgeons were concerned that our excellent results with open surgery would not be achieved with the newer robotic approach until the technique and the technology improved. Fortunately in 2013, it now appears that with further refinement to the technology by Da Vinci and further technical improvements by surgeons over recent years, results are similar, and in some patients and with certain outcome measures, superior to open surgery.

We offer Robotic assisted surgery to carefully selected patients with appropriate cancers who are motivated by this newer approach as we have been able to secure the most advanced Da Vinci Robotic surgery technology inSydney which, together with international training of our surgeons has allowed us to achieve excellent results.

There are advantages and disadvantages to each approach. For example, vision is enhanced by the robot but there is no tactile feedback, meaning the surgeon cannot feel the tissues to decide on the degree of nerve sparing to ensure complete removal of the tumour. With open surgery, the surgeon can feel areas he or she may be concerned about to optimise the chances of cure. However, on occasion visualisation of the surgical field can be sub-optimal with open surgery. Certain patients may be more suitable to one or other approach due to patient specific factors- previous surgery or hernia repair is a good example. Our surgeons will advise and make recommendations, based on our extensive experience, if you are more suitable for one approach over the other.

Our surgeons trained extensively in the USA at Vanderbilt University in Nashville with Dr J Smith and in Sunnyvale, California. Our mentoring and training of our robotic surgeons and our nursing team has been very favourably reviewed and internationally validated.

Our cancer control rates and functional results (recovery of potency and continence) are now well established with robotic surgery and appear at least equivalent and possibly superior to the early results of open surgery.

There are several very exciting refinements to the Da Vinci Robotic Surgery platform which will be available shortly and we believe these will improve the results further. As an example we have the only available technology inSydney which allows nerve sparing surgery with minimal thermal or heat energy allowing the nerve fibres to remain undamaged and therefore recovery of erections much more likely to occur.

In summary, providing your surgeon is experienced, well trained and adheres to sound surgical principles of avoiding damage to vital structures during surgery with attention directed towards complete removal of the tumour you will be assured of the best possible results. Particularly, if your surgeon is working in a well organised team environment offering the best rehabilitation of urinary control and erectile function you can expect the very best.

We are committed to providing the best technique in the best inpatient and outpatient environment with thorough and comprehensive rehabilitation, to obtain the best results possible.

Our surgeons will discuss the two approaches with you and help you decide. If you are un-suitable for one of these techniques we will advise accordingly and on occasion we do make a strong recommendation one way or the other.