First, in general terms, describe robotic surgery for cancer. What is it, and how does it work?
DR. SALARI: Robotic surgery is minimally invasive surgery that allows the surgeon to perform cancer operations through smaller incisions with great precision. The surgeon has full control of the robot at a console in the operating room. There are assistants who are also helping the surgeon at the bedside with the patient.
The robot has advanced 3D and HD viewing capabilities and ability for 360-degree range of motion that would be impossible in an open or laparoscopic surgery. For this reason, robotic surgery has essentially been standard of care over the last 10 years for urologic cancer surgery of the prostate, kidney, and bladder.
In your practice, do you use robotic surgery for anything else?
DR. SALARI: Yes, robotic surgery is used for kidney reconstruction (robotic pyeloplasty) in patients who have scar tissue of the ureter, also called strictures of the ureter. This scar tissue may be where the kidney drains into the ureter causing a ureteropelvic junction (UPJ) obstruction, or down low near the bladder at ureterovesical junction (UVJ).
Using the robot, the surgeon is able to perform complex suturing and reconstruction through small keyhole incisions. That means patients have much less pain after surgery and can go home usually within one day of the surgery.
Another very important use of the robot is in men who have very large prostates ( > 80 grams) that cause difficulty urinating and possibly urinary retention. Because the prostate is so large and patients are unable to urinate, the gold standard operation is called a simple prostatectomy.
This surgery, which cores out all of the prostate tissue to improve the flow of urine, has been done with large open incisions that caused a lot of bleeding in the past. The robotic simple prostatectomy approach reduces the bleeding significantly since the surgeon is able to identify and control small blood vessels more effectively. Again, this leads to less pain and a shorter hospital stay for the patients.
Finally, we also perform robotic varicocelectomy for enlarged scrotal veins that cause infertility in men when more traditional approaches are difficult due to prior hernia surgery, for example.
What are the biggest benefits that robotic surgery offers?
DR. SALARI: The benefits of robotic surgery are significant for both the surgeon and the patient. The surgeon is simply able to see a clearer, 3D and HD picture with magnified views. As you can imagine, we are more likely to control smaller blood vessels, which leads to less bleeding and complications in the patient.
We are also able to see anatomy deeper in the pelvis (where the bladder and prostate are located) that are much more difficult to see in open surgery. Surgeons also have more range of motion with robotic arms. This can make delicate parts of surgery, such as suturing, much easier for the surgeon.
Patients enjoy robotic surgery because it means less pain after surgery and shorter hospital stays. Pain is reduced because the incisions are much smaller and there is less bleeding during surgery. That means most patients go home the following day after surgery, and in some cases, can go home the same day they have the surgery.
Does insurance typically cover most robotic surgery?
DR. SALARI: Yes. robotic surgery is essentially standard of care for most urologic cancer operations. For example, over 80% of prostatectomies are being done robotically in the United States.
Now, let's talk specifically about robotic surgery for bladder cancer. When would that option be considered?
Bladder cancer is usually managed with robotic surgery when it becomes more advanced, involving the deeper muscle of the bladder. This is a very important surgery that prevents bladder cancer from spreading or metastasizing to other parts of the body.
Robotic surgery for bladder cancer can help reduce sexual side effects, such as erectile dysfunction in men or more precise vaginal sparing surgery in women. Also, robotic surgery is used in special situations when a partial removal of the bladder is required when a tumor is in a ballooning of the bladder wall called a diverticulum.
Moving on to robotic surgery for prostate cancer—when would that option be considered?
DR. SALARI: Robotic prostatectomy is recommended in patients with prostate cancer that has not spread to other parts of the body. Most prostate surgeries in the United States are done robotically due to the great precision and magnification offered by the robot, less bleeding, and shorter hospital stay advantages mentioned before. Robotics also make it easier to spare the erectile nerves alongside the prostate to help reduce erectile dysfunction after surgery.
While radiation remains a viable alternative in older men who cannot tolerate surgery easily, robotic prostatectomy remains an excellent option for a man with prostate cancer who wants his prostate removed from the body, wants to maintain erections, and wants to avoid diarrhea and hormone treatments that lower testosterone that are often required with radiation.
And how about robotic surgery for kidney cancer? When would that option be considered?
DR. SALARI: When a kidney tumor is found, this is often managed by surgically removing the mass (partial nephrectomy) or, if the mass is larger, removal of the entire kidney (radical nephrectomy). Surgical removal of the cancer earlier prevents metastasis of cancer to other parts of the body.
Both a partial nephrectomy and radical nephrectomy are best done robotically in order to minimize the incision size. As mentioned, smaller incisions are less painful which means patients go home after surgery quicker. The robot also has advanced technology that helps us identify important structures such as the kidney artery and vein and ureter for improved and efficient surgery. This leads to less bleeding and complications during surgery.
If there's one point about robotic surgery that you want to make sure readers take away, what would it be?
DR. SALARI: I believe robotic surgery is standard of care for urologic cancer operations and has significant benefits for both the surgeon and patient. I am happy to offer these benefits to our patients with the latest Davinci Xi robot at Cape Cod Hospital.
Thanks, Dr. Salari!
With many locations throughout Massachusetts, including MetroWest, the South Shore, and the Cape, GBU is an excellent choice for the treatment of bladder cancer, prostate cancer, and kidney cancer. Make an appointment with one of our board-certified urologists.