Our Results for Robotic Radical Prostatectomy
We have now done over 3000 operations and have been extremely impressed with our results. We have not had to convert the surgery to a conventional open operation. The average length of stay has been less than 24 hours after the operation, with over 90% of men going home after the first post-operative day. Less than 1% of men have required a blood transfusion. In our hands, recovery time has been much improved over open surgery.
We have a dedicated team including a cancer specialist nurse who takes a particular interest in patients having robotic prostatectomy, counseling them carefully before the operation, training them to do pelvic floor exercises before and after the operation and following them up after the procedure.
At 10 months follow up, 85% of our patients are pad free, with a further 10% occasionally requiring one small pad a day.
The average length of stay has been less than 24 hours after the operation, with over 90% of men going home after the first post-operative day.
Our results for robotic radical prostatectomy show that in the last 200 men, over 70% require either no pad or up to one pad a day at their 6 week follow up post-surgery.
We have been impressed by the ability to carry out a careful anastomosis (join) between the bladder neck and the urethra; this has improved urinary control compared with an open operation. There is also a lower risk of strictures compared with open surgery. In addition we have been able to preserve the delicate neuro-vascular tissue around the prostate. This has improved the ability of patients to retain erectile function and a sense of orgasm after the operation.
The cancer removing results have been good in that less than 10% of men with confined prostate cancer (pT2) have had what we call a positive margin. The risks of positive margins are dependent on the stage and grade of the cancer.
The nerves that produce penile erection run very close to the prostate gland. During robotic prostate surgery, We try to preserve the neurovascular bundles if this is compatible with removing all the cancer. We try to estimate the risk of the cancer based on the PSA level, the Gleason grade and the proportion of the biopsies affected by the cancer. This will be discussed in greater detail with you when you come up to the clinic. Preservation of the nerves can often be carried out, but is not wise in all cases. Ejaculation is lost after surgery because the seminal vesicles (sperm sacs) are removed during the operation.
Our results show that if the erections before operation are good, and if the nerves can be preserved, then erections can be regained in about three quarters of men, although some will require to use Viagra like drugs or other aids.
Lisa Geoghegan is a nurse specialist at Addenbrooke’s Hospital who will help after the operation with these issues.