Prostatectomy

The gold standard treatment option for men under 70 with early-stage, organ-confined cancer is surgical removal of the prostate using nerve-sparing radical prostatectomy. Prostatectomy is also the most widely used treatment for prostate cancer today in the US.

The primary goal of prostatectomy is the removal of the cancer. A secondary goal is to preserve urinary function and — when applicable — erectile function. Preservation of the nerves necessary for erections can be an extremely important goal for patients. These nerves run alongside the prostate and are often damaged when removing the prostate. A nerve-sparing prostatectomy attempts to preserve these nerves so that the patient may be able to return to his prior erectile function.

 

Radical Prostatectomy vs. Radiation

Comparitive Results of Radiotherapy and Surgery

 

Types of Prostatectomy

Approaches to this procedure include traditional open surgery, conventional laparoscopic surgery or da Vinci ® Prostatectomy, which is a robot-assisted laparoscopic surgery.

With a traditional open procedure, your surgeon uses an 8-10 inch incision to access the prostate. This approach often results in substantial blood loss, a lengthy, uncomfortable recovery, and a risk of impotence and incontinence.

Conventional laparoscopy uses a specialized surgical camera and rigid instruments to access and remove the prostate using a series of small incisions. This approach provides your surgeon with better visualization than an open approach. In addition, it provides patients the benefits of a minimally invasive procedure.

 

Da Vinci vs. Conventional Laparoscopy

Comparitive Chart of Different Prostatectomies

Despite these advantages, conventional laparoscopy relies on rigid instruments and standard 2D video, technical limitations that can be challenging for the surgeon. Because of these drawbacks, conventional laparoscopy doesn’t lend itself well to complex procedures like prostatectomy. Therefore, very few urologists use this approach for prostatectomy.

Learn More

Read about robotic prostatectomy:
da Vinci® Prostatectomy

Read more about prostate cancer treatment options: Project Zero: the project to end prostate cancer

Read more about prostate cancer treatment options:: Us Too Prostate Cancer Support Group

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual.

Always ask your doctor about all treatment options, as well as their risks and benefits.

Prostatectomy for BPH

The treatment of benign prostatic hypertrophy (BPH) has changed dramatically over the last few years. Medicines have reduced the size of the prostate and reduced the need for surgery.

Many minimally invasive prostate procedures have been developed including TUNA, TUMT (microwave), and laser prostatectomy. TURP remains the gold standard for treatment of BPH, although most prostates that are under 80 grams can be treated with newer treatments. Dr. Savatta has been performing urolift and rezum since 2016.

For prostates that are too big for a successful long term options there have been few choices. Laser enucleation (HOLEP) has been performed in a few centers of excellence, but is difficult to master. 

The treatment of choice for very large prostates is the Robotic Simple Prostatectomy. This operation is similar to the open suprapubic prostatectomy for BPH, but has significantly less blood loss, a shorter hospital stay, and a quicker recovery.  This operation removes the inner part of the prostate that is responsible for the blockage.  Hospital stays and blood loss have been drastically reduced from switching from the open to the robotic version of the operation.  I have been performing a reconstructive surgery as part of this operation for some patients to help patients recover faster.

I have one of the world’s largest series of this complex operation. Patients have traveled from outside the country to have him perform this operation.

 

da Vinci Robotic Prostatectomy

Bloodless Prostate Cancer Surgery

Prostate cancer management has had significant advances since the turn of the century. Surgery has been the gold standard of treatment for cancer cure, but complications of impotence and incontinence, prolonged hospital stays and risks of blood loss have been cited as incentives for patients to seek out less invasive approaches, even if success rates were not quite as high.

Referred to by many as robotic surgery for prostate cancer or robotic prostatectomy, da Vinci® Prostatectomy can be a more accurate, robot-assisted, minimally invasive surgery that is quickly becoming the preferred treatment for removal of the prostate following early diagnosis of prostate cancer. In fact, studies suggest that da Vinci Prostatectomy may be the most effective, least invasive prostate surgery performed today.

Robotic Prostatectomy represents a quantum leap forward in our ability to effectively treat prostate cancer, reduce hospital stays, and minimize the risk of complications. In addition, in my opinion, the long-term sexual and urinary bother symptoms can be less than for current surgical techniques or any form of radiation therapy as well. Dr. Savatta has been performing athermal nerve-sparing robotic prostatectomy since 2004.

 

Open Surgical Incision vs. Da Vinci Prostatectomy Incision

 

Advantages of the minimally invasive robotic procedure can include reduced pain, scarring, incision size, risk of infection, and less operative blood loss. Patients typically stay in the hospital overnight and return to work within one to two weeks. Continence is achieved more quickly and completely than with traditional surgical techniques. Dr. Savatta has been performing reconstruction of the rhabdosphincter to aid in return of urinary control during the prostate cancer surgery since 2007. In addition, the neurovascular bundles that are responsible for erections can be dissected from the prostate less traumatically, and therefore erectile function can be regained more quickly and with greater frequency.

About forty percent of Dr. Savatta’s patients who have normal erections before surgery and have both nerves spared have reported regaining erections and having intercourse within 1 month of surgery. In short, with the da Vinci® Surgical System and an experienced surgeon, prostate cancer patients can finally realize the promise of effective cancer control with significantly less morbidity.

Dr. Louis Galdieri assisted Dr. Domenico Savatta in performing the first Robotic Prostatectomy in Essex, Morris, or Union counties. This was done at Newark Beth Israel in December of 2004.

Patients have come from as far as California, Europe, and Africa to have daVinci prostatectomy surgery.

1. Most effective minimally invasive surgery in terms of cancer control, potency and continence, cancer control being defined in part by margin rates and PSA test scores. The following studies provide support for da Vinci Prostatectomy’s effectiveness in these three areas: Ahlering TE, Woo D, Eichel L, Lee DI, Edwards R, Skarecky DW. Robot-assisted versus open radical prostatectomy: a comparison of one surgeon’s outcomes. Urology. 2004 May;63(5):819-22. Menon M, Tewari A, Peabody JO, Shrivastava A, Kaul S, Bhandari A, Hemal AK. Vattikuti Institute prostatectomy, a technique of robotic radical prostatectomy for management of localized carcinoma of the prostate: experience of over 1100 cases. Urol Clin North Am. 2004 Nov;31(4):701-17. Tewari A, Srivasatava A, Menon M; Members of the VIP Team. A prospective comparison of radical retropubic and robot-assisted prostatectomy: experience in one institution. BJU Int. 2003 Aug;92(3):205-10. Please also see the Clinical References section of the site for additional clinical support.

While clinical studies support the effectiveness of the da Vinci® System when used in minimally invasive surgery, individual results may vary. Surgery with the da Vinci Surgical System may not be appropriate for every individual.  Any surgery has inherent risk from the operation as well as the anesthesia. Always ask your doctor about all treatment options, as well as their risks and benefits.

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