Urology CancerCARE News Archive Featured in the Media JeffNEWS Prostatectomy

Not long ago, men with prostate cancer had rather limited treatment choices.

But newer technological advances now make it possible for the internationally recognized urologic specialists at Thomas Jefferson University Hospital to offer another advance in less invasive laparoscopic prostatectomy.

The latest tool in their hands is a futuristic, state-of-the art robotic technology, called the daVinci ® System, that allows them to perform a less invasive, laparoscopic radical prostatectomy, by using a small, thin tube with a scope on the tip to see inside the body and remove prostate tissue.

“We welcome the DaVinci robot as another option for prostate cancer patients who are seen at the Kimmel Cancer Center,” said Leonard Gomella, M.D., FACS, chair of Urology, Jefferson Medical College of Thomas Jefferson University. Jefferson’s multidisciplinary Genitourinary (GU) cancer center celebrates its 10th anniversary in January. “We were the first institution in the Delaware Valley to offer laparoscopic prostatectomy in 2000 and have the longest experience in the region. We are pleased to offer robotically assisted laparoscopic prostate surgery as an additional option for our patients cared for at our multidisciplinary cancer center.”

“Laparoscopic surgery offers potential advantages to patients; less trauma through smaller incisions, faster recovery and less overall blood loss during surgery,” said Dr. Gomella, the Bernard Godwin, Jr. Professor of Prostate Cancer in the Department of Urology, and director of Urologic Oncology, Kimmel Cancer Center at Jefferson. “Patients may be out of the hospital in one to two days.”    

The new robotic system further refines laparoscopic prostatectomy by allowing a surgeon’s hand movements to be scaled, filtered and translated into precise movements of micro-instruments within the operative site. The magnified, three-dimensional view the surgeon experiences enables him or her to perform precise surgery in complex procedures such as radical prostatectomy through small surgical incisions. 

Edouard Trabulsi, M.D., assistant professor of Urology, Jefferson, a urologic oncologist who is an expert trained in laparoscopic prostatectomy by one of the pioneers of the technique, and Costas Lallas, M.D., assistant professor of Urology, Jefferson, who completed a robotic surgery fellowship at the Mayo Clinic, are leading the first robotic efforts at Jefferson.

The American Cancer Society (ACS) reports that one in six men will develop prostate cancer in his lifetime. African-American men are at higher risk than other groups, as are those with family histories. For all men, the risk of developing prostate cancer increases with age. More than 75 percent of all prostate cancers occur in men over 65.  Because of early detection and improved treatment, the survival rate for prostate cancer continues to rise. Most prostate cancer is now diagnosed while it is still confined to the prostate.

One treatment for prostate cancer is radical prostatectomy, the surgical removal of the entire prostate gland and surrounding tissue including the seminal vessels.

Laparoscopic prostatectomy is a less invasive procedure for a patient. The prostate is removed through several tiny incisions, including one in the navel. The laparoscope is passed though the navel, and other small incisions create portals for instruments. The laparoscope is outfitted with a camera that allows the surgeon to see on a video screen what he or she would not otherwise be able to see without a large, open incision.

Like traditional open prostatectomy, laparoscopic prostatectomy involves a reconstruction of the urinary tract. In the laparoscopic procedure, the surgeon approaches and removes the prostate above from the bladder and below from the urethra. Then he or she sews the bladder back to the urethra.

Under normal circumstances, the laparoscopic prostatectomy takes three or four hours. The laparoscopic procedure sometimes takes longer than traditional prostatectomy in the operating room, but in most cases, in the end, offers great advantages. It appears to be equally effective in treating cancer as the traditional surgery.

In the robotic prostatectomy, the laparoscopic approach is also used.

The robot cannot be programmed nor can it make decisions on its own. The system requires that every surgical maneuver be performed with direct input from a surgeon, Dr. Gomella noted. “The daVinci prostatectomy has been used successfully in thousands of prostate cancer procedures world-wide,” he said. 

Dr. Gomella cautions that not all patients are candidates for robotic prostatectomy. “A consultation with the team at the GU oncology center allows the patient and his family to discuss all treatment options so they can determine which may be the best for that individual patient,” he said.

For more information about the daVinci prostatectomy procedure, to make an appointment with a Jefferson urologist:

• visit the Department of Urology at Jefferson
• or call 1-800-JEFF-NOW.