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Robotic radical prostatectomy

Removal of the prostate (radical prostatectomy) remains the gold standard for management of prostate cancer, with current evidence confirming superior survival rates compared to radiation therapy (especially for intermediate and high risk disease), and lower rates of long term complications [1].  

Radical prostatectomy is removal of the whole prostate, with attached seminal vesicles, followed by reattachment of the urethra to the bladder opening, over a catheter.  The urinary sphincter muscle is immediately below the prostate and this needs to be carefully preserved then joined back to the bladder precisely to avoid problems with bladder control or blockages caused by scarring  after surgery.  The erectile nerves run alongside the prostate, and can be preserved if the cancer is early stage, or deliberately resected if affected by the cancer.

Robotic surgery allows this operation to be performed  through key-hole surgery with the best possible view of the prostate and surrounding anatomy, magnified through 3-dimensional high definition digital vision.  The instrumentation enables a surgeon to operate around the contours of the prostate, and perform the reconstruction of bladder to urethra under direct vision.  Compared to open surgery this leads to reduced bleeding, less pain, a quicker recovery, and lower risk of scarring at the bladder-urethra join [2].    A/Prof Moon has published data confirming that this approach can also be offered to selected men over 70 who have aggressive prostate cancer without a greater risk of incontinence, as traditionally believed by those performing open surgery [3].  A/Prof Moon has also shown this approach is even possible in men with early metastatic disease (cancer that has begun to spread from the prostate)

The chance of completely removing the cancer, and recovering bladder control (continence) or potency (erection) after radical prostatectomy depend most upon the surgeon’s skill and experience.

1. Wallis C, Saskin R, Nam R et al. Surgery Versus Radiotherapy for Clinically-localized Prostate Cancer: A Systematic Review and Meta-analysis.
Eur Urol 2016 Jul;70(1):21-30
2. Basto M, Sathianathan N, Marvelde LT, Ryan S, Goad J, Lawrentschuk N, Costello AJ, Moon D, Heriot A, Butler J, Murphy DG.  A patterns of care and health economic analysis of robotic radical prostatectomy in the Australian public health system.  BJU Int (In Press, epub Sep 9 2015) 
3. Basto M, Vidyasagar C, Marvelde L, Freeborn H, Birch E, Landau A, Murphy D, and Moon D.  Early urinary continence recovery after robot-assisted radical prostatectomy in older Australian men.  BJU Int 2014 Nov;114 Suppl 1:29-33
4. Katelaris N, Murphy D, Lawrentschuk N, Katelaris A, Moon D.  Cytoreductive surgery for men with metastatic prostate cancer. Prostate International (In Press 2016)  

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