Comparing Robotic Vs. Open Prostate Surgery

 henryfordhealth.org-There are many ways to treat prostate cancer, and each method has its own advantages. We at Henry Ford are sharing with you our experience with;both robotic prostatectomy and open prostatectomy so that you can make an informed decision.

Making the Decision


Patients  are most concerned about the following factors when deciding what type of prostate cancer treatment to undergo:

• Cancer Removal
• Urinary Continence
• Erectile Function
• Safety
• Pain
• Blood Loss

Cancer Removal

Whether a cancer can be completely removed depends on several factors - including the skill of the surgeon, the tumor volume (how much cancer there is) and tumor grade (how abnormal the cancer looks under a microscope).  Any surgeon, no matter his or her skill, will not be successful in removing all the cancer if the cancer is particularly aggressive.


Success in eliminating cancer is measured in terms of "PSA recurrence" - the same PSA test that probably led to your cancer diagnosis in the first place. The American Urological Association defines a value of >0.2, if confirmed with a second value, as a PSA recurrence after prostatectomy. If there is no PSA recurrence, you are safe. If the PSA does come back, you may still be safe, but about 10-20 percent of the time, the cancer will spread to other parts of the body, and it is better to get additional treatment, such as radiation, hormones or chemotherapy.


Urinary Continence 
Patients who undergo the VIP regain continence much faster than patients undergoing open prostatectomy. When the prostate is removed, one of two muscles that control urination also is removed because this muscle lives in the prostate. Until the second muscle is able to develop, a patient may leak urine.
Incontinent patients wear pads to contain their urinary leakage. For patients having robotic prostatectomy with a catheter-free technique, 92 percent are continent at one month and 96 percent are not wearing pads at six months. For patients undergoing open prostatectomy, 25 percent are dry at eight weeks and 60 percent are not wearing pads six months after surgery.


Erectile Function

One very common side effect of prostate cancer treatment - surgery, radiation, or hormone treatments - is erectile dysfunction, or the inability to have and sustain an adequate erection for sexual intercourse. While sexual desire, orgasm and sensation remain the same, most men notice a change in the quality of their erections because the nerves and blood vessels required for erections often are stretched or cut during prostate surgery.


Over a period of two to three years, erections should return. The rate of return depends on emotional factors, age, the partner, the level of current sexual activity and whether the surgeon was able to preserve the nerves.
97 percent who underwent nerve-sparing robotic prostate surgery had return of erectile function. About 84 percent of men responded that they were "back to normal," while the other 13 percent had erections strong enough for intercourse, but weaker than before surgery. As with continence, VIP patients appear to regain erectile function faster than patients undergoing open surgery, and it is likely that these results will improve with time. There also are many methods to improve sexual function, and we encourage using these.


Catheter-free Recovery
For most men, one of the biggest complaints about prostate surgery is discomfort from the urethral catheter. To address this issue, some doctors use a surgical technique that eliminates use of the catheter. Urine is drained instead through a small tube, much like an IV tube, through the abdomen. The response from patients has been truly remarkable. Make sure you ask us if this option is right for you.


Safety

No matter how routine, there are risks to every operation. However, those risks are reduced with the VIP procedure. Complications during surgery can include a hernia at the "port," where the scopes are inserted into the body, post-operative bleeding, a deep venous thrombosis or blood clots that develop in the veins of the legs and the pelvic region.


Pain
Patients who had the Robotic Prostatectomy generally have less pain compared to patients who had the open prostatectomy. 



Blood Loss
The risk of blood loss with Robotic Prostatectomy is much lower compared to open surgery.
The prostate has multiple large blood vessels surrounding it, and bleeding during surgery is a common risk. Sometimes, blood loss is so significant that patients need a transfusion to replace what is lost.


Even though most patients undergoing open prostatectomy do not require a blood transfusion, most of them are anemic when they go home. More than 97 percent of robotic prostatectomy patients are not anemic at time of discharge and are able to resume normal activity more quickly than the open surgery patients.