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Robot-assisted BPH surgery

It might sound like something out of a science fiction movie, but robots are performing more and more surgeries these days, particularly prostatectomies – removal of part or all of the prostate gland.

Prostatectomies are a common treatment for prostate cancer. They’re sometimes used to treat enlarged prostate (also called benign prostatic hyperplasia or BPH) symptoms as well. However, this surgery is usually reserved for men whose prostate has grown considerably, to 80 grams or more.

How would you feel about having a robot perform your surgery? Today we’ll look at some of the questions and concerns that come up when patients make this decision. Keep in mind that only you and your doctor can determine what is best for you.

How common is robot-assisted surgery?

Robot-assisted surgery has become very common. Approximately 70,000 to 90,000 of prostatectomies done each year are now robot-assisted. This technology is also used to treat uterine, endometrial, and cervical cancer.

How long has robot-assisted surgery been around?

Surgeons have been performing robotic-surgery for about ten years. The technology was originally developed by the U.S. Department of Defense.

How does robot-assisted surgery work? Does the robot really do the surgery?

In a sense, yes, but the robot is controlled by the surgeon, who sits at a computer console. The robot and console are connected by cables. The surgeon is usually in the same room or an adjacent room. But sometimes robotic surgery can be performed from farther away.

The robot sits on a sterile surgical cart next to the patient. It has about 3 or 4 arms that hold surgical instruments, such as scissors, forceps, and clips. The instruments can be changed as the surgeon wishes. The robot also has a flexible wrist that make it easier for it to maneuver these instruments.

A special camera is used so that the surgeon, sitting at the console, can get a three-dimensional view of what’s happening. The surgeon uses hand mechanisms and foot pedals to control the robot’s movements. This all happens in real time – what the surgeon sees on the console is exactly what the robot is doing at a given moment.

What kind of training does a surgeon need to do robot-assisted surgery?

Surgeons performing this type of procedure undergo extensive training. Some surgeons get this training in medical school; others take special courses. Many practice on animals before they work with human patients. And once they do start working with humans, most have experienced mentors at the console with them, ready to guide them if necessary.

What are some of the benefits of robot-assisted surgery?

Here are some of the benefits:

  • With the flexible wrist, the robot is able to maneuver in ways and in places that a surgeon’s hand cannot. It makes steadier, smaller movements.  This allows for more precision.  
  • Robotic surgery is less invasive than traditional open surgery. The incisions are generally smaller. It takes less time for smaller incisions to heal.
  • Many patients who have robot-assisted surgery have a slightly shorter stay in the hospital.
  • Some patients experience less pain and bleeding. The risk of infection is also usually lower.
  • Robot-assisted surgery can take less time than traditional surgery.
  • The console display can be magnified, making it easier for the surgeon to see the surgical site.

What are some of the disadvantages to this procedure?

The robot and related equipment can take up a lot of room, making the operation site more cramped.

Robot-assisted surgery is also very expensive. One robotic system can cost over $1.2 million and hospitals can spend $100,000 to $150,000 each year for its maintenance. Therefore, not every hospital can offer robot-assisted prostatectomies.

What if the robot malfunctions?

The robot cannot work independently of the surgeon, so if there is a malfunction, the surgery will stop. Most hospitals have backup machines that can take over.

The surgeon may also decide to finish the procedure laparascopically or openly.

What if I don’t want a robot working on me?

You don’t have to. You still have the option of having traditional open or laparoscopic surgery. Talk to your doctor about your concerns.