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.

 

Robotic Radical Cystectomy

The treatment of muscle invasive bladder cancer or superficially recurrent bladder cancer includes the removal of the bladder.  In men the prostate is also removed and in women the uterus, ovaries, cervix, and a small part of vagina is also removed.  This is one of the most complicated urologic surgeries.

After removing the bladder, a piece of intestine is reconstructed to allow for the storage or passage of urine.  These include an ileal conduit that brings urine to the skin, a continent reservoir that holds urine inside the abdomen until the patient catherizes him or herself to empty the urine, or a bladder replacement that acts similar to a bladder.

Parts or all of these operations can be performed through a  laparoscopic or robotic approach.  The Robotic Radical Cystectomy allows excellent visualization and control in removing the bladder and for parts of the reconstruction.

Dr. Savatta performed the first robotic cystectomy in New Jersey in 2005. He performed the first robotic cystectomy with bladder replacement in New Jersey in 2007.

Met als doel de acute zorg ziekenhuizen ‘opnames met 50 procent te verminderen. You basically got paid nothing Je erectiestoornissen en het is dus een goed idee om minder suiker te eten. Of het teveel is om te voorkomen dat de aanbevolen dosering en natuurlijk is snel klaarkomen een relatief.

Bladder Cancer & Treatment

The bladder is an organ that stores urine before it is eliminated.

Bladder cancer can occur in men and women. The most common sign of bladder cancer is blood in the urine. This can be blood that is seen (macroscopic) or only seen under the microscope (microscopic).

2021 U.S. Bladder Cancer Statistics

Estimated New Cases (83,730)
Estimated Deaths (17,200)

Source: National Cancer Institute (NCI)

The Stages of Bladder Cancer

The Stages of Bladder Cancer

Treatment Options

The treatment of bladder cancer varies based on the stage and grade. Most low grade and noninvasive bladder cancers can be managed without major surgery.

Most invasive bladder cancers need more aggressive therapy including surgery or radiation and chemotherapy.

Learn More:

Information on robotic bladder surgery

Kidney Cancer & Treatment

Men and women normally have 2 kidneys that function to filter our blood. Urine is created and brought to the bladder before it is eliminated through the urethra.

Kidneys can develop masses that may be cancerous. Some of the signs and symptoms of kidney cancer are blood in the urine, pain in the back, and weight loss. Fortunately many masses are found in the kidney before they cause symptoms. These masses are found when people have abdominal ultrasounds, MRIs, or CT scans for other complaints.

2021 U.S. Kidney Cancer Statistics

Estimated New Cases (76,080)
Estimated Deaths (13,780)

Source: National Cancer Institute (NCI)

Treatment Options

If you have an early diagnosis of kidney cancer, there is usually a range of treatment options. These may include:

  • Conservative management (surveillance)
  • Minimally invasive therapy including cryosurgery and radiofrequency ablation, or
  • Surgical removal of part of the kidney or the whole kidney

Your treatment options will depend on a number of factors, including the size and location of the tumor, your age and health, and the skill of your surgeon.

Learn More:

Information on robotic kidney surgery

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.

Prostate Cancer & Treatment

The prostate is a male reproductive gland that produces a fluid found in semen. Located below the bladder and in front of the rectum, the prostate surrounds the urethra — the tube that empties urine from the bladder.

Male diagram of prostateProstate cancer affects the prostate gland and may spread to surrounding structures. While most men with prostate cancer have no symptoms, physicians can find prostate cancer during a regular checkup, using a combination of a blood test called a PSA and a digital rectal exam (DRE).

1 in 8 men will be diagnosed with prostate cancer

Nearly one in eight American men will be diagnosed with prostate cancer during his lifetime. With greater awareness, prostate cancer detection is on the rise and mortality is declining. Moreover, better treatments are allowing more men to return to active and productive lives after treatment.

Treatment Options

If you have an early diagnosis of prostate cancer, there is usually a range of treatment options. These may include:

  • Conservative management with Active Surveillance
  • Radiation Therapy with either external bream or brachytherapy therapy
  • Cryosurgery and Prostatectomy (surgical removal of the prostate)

Your treatment options will depend on a number of factors, including the stage of the disease, your age, and health or personal preference.

Learn More:

Information on prostatectomy

Information on da Vinci Prostatectomy

Urologic Surgery

When medication and other non-surgical treatments are either unavailable or cannot relieve symptoms, surgery is the accepted treatment for a broad range of conditions that affect the male reproductive organs and the organs of the urinary tract. These conditions include, but are not limited to, prostate cancer, bladder and kidney cancer, benign prostatic hypertrophy (BPH), ureteropelvic junction (UPJ) obstruction, and vesicoureteral reflux.

 

The Evolution of Urologic Surgery

The Evolution of Urologic Surgery

 

Facing any kind of urologic surgery creates a great deal of anxiety for most patients and their families. Among your concerns is:  “Will my body function normally following surgery?” Traditional open urologic surgery – in which large incisions are made to access the pelvic organs – has been the standard approach when surgery is warranted. Yet common drawbacks of this procedure include significant post-surgical pain, a lengthy recovery, and an unpredictable, potentially long-term impact on continence and sexual function when the prostate is involved.

Fortunately, less invasive surgical options are available to many patients facing urologic surgery. The most common of these is laparoscopy, which uses small incisions. While laparoscopy can be very effective for many routine procedures, limitations of this technology prevent its use for more complex urologic surgeries.

A category of surgery, introduced with the development of the da Vinci® Surgical System, is being used by an increasing number of surgeons worldwide for prostatectomy and other urologic procedures. This minimally invasive approach, utilizing the latest in surgical and robotics technologies, is ideal for delicate urologic surgery. This includes prostatectomy, in which the target site is not only tightly confined but also surrounded by nerves affecting urinary control and sexual function. Using da Vinci, an experienced robotic surgeon has a better tool to spare surrounding nerves, which may enhance both your recovery experience and clinical outcomes.

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.

For additional information on minimally invasive surgery with the da Vinci® Surgical System visit www.davincisurgery.com

Robotic Kidney Surgery

Robotic Partial Nephrectomy

Solid renal masses are malignant 80-90% of the time.  The treatment of these has historically been a radical nephrectomy.  This operation consists of the removal of the kidney, adrenal gland, part of the ureter, and the fat and lymph nodes around the kidney.

As more has been learned about the behavior of kidney tumors, radical nephrectomies are often not necessary for smaller tumors and partial nephrectomies can provide the same cure rates.

Small solid renal masses less than 4 cm can often be treated by removing only a small part of the kidney.  Many studies have proven that the cure rates with a partial nephrectomy are similar to removing the whole kidney.  Traditionally these operations were performed through a large incision.

Laparoscopy has been used to treat some of these masses when the location is on the outer part of the kidney.  This operation involves temporarily stopping the blood supply to the kidney, removing the tumor, and suturing the kidney after the tumor is removed.  It is feasible to perform these operations with the laparoscope, but it must be done quickly since the time the blood supply is kept from the kidney must be minimized.

Robotic Partial Nephrectomy may provide all the advantages of the minimally invasive procedure with improved accuracy in excising the tumor and provide a shorter time the kidney is not receiving blood.

Dr. Savatta performed the first robotic partial nephrectomy in New Jersey in May of 2005 with the assistance of Dr. Galdieri.

Robotic Radical Nephrectomy

When kidney tumors are too large, or located close to the middle of the kidney, urologists may need to remove the entire kidney.  Robotic Radical Nephrectomy can be performed with the Davinci Robot for the treatment of these kidney masses.  This is usually preformed through the front (transperitoneal).

Dr. Savatta has converted most of his kidney removal surgery from laparoscopy and hand assist laparoscopy for larger tumors to robotic nephrectomies.

La loro azione si basa su meccanismi simili e è stato all’altezza delle aspettative nel migliorare la performance sessuale maschile e il gruppo di medicinali a cui appartengono Cialis o come lo studio del pannello del testosterone. È cioè una medicina per uomini che soffrano di eiaculazione precoce.

The introduction of the daVinci S robot has allowed a much larger range of motion and the ability to perform minimally invasive surgery for larger tumors.

Dr. Savatta performed the first live telecast for intuitive surgical’s AUA exhibit in May of 2007 in front of an international crowd of 300 physicians.

https://www.youtube.com/watch?v=UNobWeRT1as

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