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Robotic Prostatectomy Outcomes

Experience Equals Outcomes

Published studies on the treatment of prostate cancer can vary widely in many aspects. There is, however, one consistent theme: the level of expertise of the surgeon evaluating and treating the cancer patient is key to each patient’s outcome.

The Global Robotics Institute has a 99 percent patient satisfaction rating. Each surgery is customized in relation to the patient’s progression of cancer. Our approach to treatment always aims to achieve the “trifecta” result. First and foremost, the robotic prostatectomy aims to remove the cancer. Additional priorities are placed on quickly regaining urinary continence and sexual function. This trifecta approach centers on the patient being able to resume a normal, healthy life that is free of cancer, following a short recovery.  In robotic surgery, the level of experience of the surgeon often equates with the outcome of the surgery. Dr. Patel has now performed over 10,000 of these procedures.

Always a step ahead, the team’s focus also extends to two additional optimal results – culminating in a “pentafecta.” These two outcomes include no post-operation complications and negative surgical margins.  Together, this is the ultimate goal for each patient.  

 

Step One: Cancer Removal

Completely removing the cancer is the primary goal of every prostate cancer operation. This is not always possible, depending upon the stage and aggressiveness of the cancer. However, our team has consistently demonstrated excellence in completely removing the cancer and returning the patient to a healthy state. Cancer reoccurrence rates are extremely low for patients with organ-confined disease.

 

Step Two: Quickly Achieving Urinary Continence

Incontinence after prostate surgery is a concern shared by many patients and is related to the most difficult challenges the surgeon faces during the procedure. Fortunately, our experience with helping men regain urinary continence shortly after surgery has been increasingly positive as our technique has evolved. With increased surgical experience and refinement of technique, our results have continually improved. The Global Robotics Institute has achieved some of the top published results worldwide. In our published results, over 95 percent of our patients regain urinary continence after robotic prostatectomy. In any prostatectomy surgery, it is possible that some patients with certain medical conditions, abnormal anatomy or physiology may not fully regain urinary continence.  However, we have optimized our surgery results by performing various technical innovations based upon our experience.  Our data shows that the return of urinary continence is highly likely, but the risk of not regaining it is always a possibility.  Patients should ask their doctor about their individual results.

Dr. Vipul Patel’s published innovative technique offers benefits like:

Maximizing urethral length to minimize the potential for damage of the urinary sphincter for continence (Source: Eur Urol. 55(3):629-37. 2009 Mar.)
• Reconstruction of the pelvic floor continence mechanisms during surgery to stabilize the bladder and urethra to allow early recovery (Source: BJU Int. 102(10):1482-5. 2008 Nov.)
• Bladder neck tapering and a watertight anastomosis to allow early urinary catheter removal and recovery (catheter is typically removed at four or five days post-surgery, resulting in less discomfort for the patient) (Source: BJU Int. 104(6):878-81. 2009 Sep.)

 

Step Three: Maximizing Early Recovery of Sexual Function

When faced with a prostate cancer diagnosis, primary considerations are usually focused on removing the cancer, but the ability to resume intimacy is another important issue. The possibility of impotence is a valid concern, as the nerves responsible for proper erectile function are small, fragile and attached to the prostate. These aspects can make them difficult to protect from damage, especially in a conventional surgery. One of the clear advantages of robotic-assisted surgery performed by an experienced surgeon over conventional open or laparoscopic surgery is in the preservation of these delicate nerves and the ability to regain early sexual function.

Our expertise has led us to a few important conclusions:*

• Surgeon experience and surgical technique is directly correlated with potency outcomes
• Trauma to the neurovascular bundle can result in impotence; this is minimized in the hands of those with significant experience
• The ability to preserve nerves is dependent upon the cancer and on the surgeon’s experience and assessment during surgery
• Our signature technique of releasing the nerves in a retrograde manner prior to mobilizing the prostate has been shown to facilitate the early return of sexual function

*Retrograde Versus Antegrade Nerve-Sparing during Robot-Assisted Radical Prostatectomy: Which is better for Achieving Early Functional Recovery? (Ko YH, Coelho RF, Sivaraman A, Schatloff O, Chauhan S, Abdul-Muhsin HM, Carrion RJ, Palmer KJ, Cheon J, Patel VR.; Eur Urol. 2013 Jan; 63(1):169-77. doi: 10.1016/j.eururo.2012.09.051)

In the ideal situation, if patients have normal function prior to surgery and receive full nerve preservation, their chances of regaining normal sexual function are very good.  Nearly 90 percent of our patients with normal function going into surgery who have full bilateral nerve preservation regain sexual function. The Global Robotics Institute’s approach to nerve preservation, including eliminating the use of thermal energy around the nerves while releasing the nerves away from the prostate early in the surgery in a retrograde manner with minimal traction or trauma, has contributed greatly to our success. Potency recovery periods are variable in each patient and are dependent upon multiple factors. These factors can include: pre-operative function, type of nerve preservation performed, any difficulties encountered during surgery, and patient compliance with the rehabilitation protocol.

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