In response to a question from one of the readers, I will further elaborate on the robotic assisted laparoscopic prostatectomy and how it relates to erectile dysfunction. Around the year 1997 the laparoscopic prostatectomy was introduced. This allowed us to remove the prostate via small incisions. The procedure, however, is very difficult, requiring the surgeon to perform a multitude of cases to become proficient (60-100).
The surgical robot is a master-slave device (meaning that the surgeon sits at a console located in the operating room alongside the patient). The robot is attached to the patient who is anesthetized in the same room. The movements of the surgeon's hands at the console (outside the body) are mirrored by the robotic instruments that are placed inside the body.
The robot allows the same benefits to the patient (quicker return to baseline activity, less blood loss, and smaller incisions), and research has shown that it requires less cases to become proficient as a surgeon. This allows the benefits of "keyhole incision" surgery to be more readily offered by your urologist's practice.
There are projected benefits with regard to erectile dysfunction in patients undergoing robotic surgery for prostate cancer. By projected, I am referring to the fact that the field of robotic surgery is relatively young, and these benefits have yet to be fully proven. It takes a large amount of these surgeries to be performed and a very long follow up to have adequate information to make such conclusions. These projections are made based on three main factors unique to the robot. The first is the robot's enhanced magnification. Compared to standard laparoscopy, the robot magnifies the field several times to place the operative field even closer to the surgeon. The bundles responsible for erection lie alongside the prostate as I have previously mentioned. The nerves themselves are not readily visible, and we must rely on the visible blood vessels that run with the nerves to identify where the nerves are "likely" located. To the naked eye, this is almost impossible. However, with the robotic magnification, the vessels can usually be seen, and, in the appropriate patients, spared and not damaged.
The second factor is related to the robot's ability to view the surgical field in three dimensions. Standard laparoscopic cameras only can allow two-dimensional visualization. Imagine watching the image on a standard television of a person walking a dog. Now compare this to a person in "real life" walking the same dog right in front of you. Obviously, you will have greater depth perception from the live image.
Another benefit is related to the movement of the robotic instruments. Standard laparoscopic instruments can only move with four degrees of freedom. The robotic instruments can move with six degrees of freedom which mimic the human hand. I often give the analogy of trying to pick up a piece of food with chopsticks versus simply using your hand to pick up the food. This is the primary reason why it historically took surgeons so long to become proficient in laparoscopic prostatectomy. The robot makes it much easier.
With regard to the nerve bundles responsible for erection, if the robotic instrument can "bend" to contour the prostate or maneuver to enter a smaller space, the delicate structures can then be better spared. Videos do exist online if you are interested in seeing the surgical robot in action.
Published On: September 17, 2007