In my opinion most patients with prostate cancer are candidates for robotic prostate cancer surgery, or the daVinci Prostatectomy.
The ideal patient would be one with early prostate cancer that is likely confined to the prostate. The patient also needs a good chance of living at least 10 years.
Certain surgeries and medical conditions can make a patient less than ideal, but probably still a candidate.
Read on to find out my take on certain conditions and please comment if you can think of any others.
Medical Problems-
I have successfully completed robotic prostate surgery on patients with recent heart surgery, heart attacks, lung disease (COPD, asthma), insulin dependent diabetes, sleep apnea, prior strokes, prior blood clotting disorders, anemia, GI problems (inflammatory bowel disease), and multiple sclerosis (MS), and HIV.
By itself I haven’t had to turn down anyone for robotic prostatectomy based on medical issues. It is important to make sure the patient has a life expectancy that warrants surgery however.
The advantages of robotics for some of the above include:
Less chance of infection, especially in diabetics.
Less trouble breathing postoperatively for the lung patients since there is less pain.
Less trouble getting around for patients with MS.
Less chance of getting a blood transfusion with the anemic patients. Several patients with anemia are included in my first 70 dvPs without a transfusion.
Less chance of a surgeon contracting HIV with robotics than open.
Past Surgeries
Prior TURP- prostate surgery- makes the surgery more challenging, but in my hands only adds about 15 minutes to the operation.
Prior Appendix removal- need to remove scar tissue, adds 5-20 minutes and a very small risk of intestinal injury (<1%).
Prior colon surgery for infection or cancer, adds a variable amount of time and a small risk of injuring the intestines (<5%) and a small risk of needing to convert (5%). One patient of mine had a colon surgery and a hernia left over from that surgery.
Prior hernia repair- no big deal unless it was done laparoscopically (in that case adds 20-30 minutes to expose the prostate.
Hernias
If a patient has an umbilical hernia this will be fixed at the same time and only adds 5 minutes.
If a patient has an inguinal hernia or if I find one, I fix it at the same time.
Obesity
This is an important point. Some surgeons do not feel comfortable operating on obese patients, but in my opinion these are the patients that are helped the most by this kind of surgery. The incisions would be larger, the risk of wound infections would be larger, and the overall complication rate would be larger.
My last 7 guys weighing between 230 and 290 pounds all went home the next day. The connection is much harder to make for the heavier patients and there is a greater chance they will need the catheter for more than 1 week. Most of my early guys have the catheters in for more than 1 week, but only 2 of the last 7 needed to for more than 1 week.
My philosophy is to offer these patients surgery and if they can loose weight, I think its much easier on me to do their surgery, but I have never refused to operate on someone for weight alone.
Age
The oldest patient I have done a dvP on is 74, but I think it woudl be reasonable to go to 80 years old if the patient has a 10 year life expectancy.
Prior Prostate Cancer Therapy
Hormonal Therapy- Makes the surgery a little more difficult.
Radiation or Cryosurgery- See previous blog entry.