With the advent of the da Vinci™ robot, Tulane University Health Science Center was among the first in the United States to acquire this advanced therapeutic option for management of prostate cancer. A minimally invasive surgical procedure, robotic prostatectomy uses finely controlled robotic instruments to safely perform the prostatectomy, while enhancing patient recovery and outcome. Powered by state-of-the-art robotic technology, the hand movements of surgeons are scaled, filtered, and seamlessly translated into precise movements via the EndoWrist instruments. More specifically, the EndoWrist instruments can turn in all directions, with 90 degrees of articulation and 7 degrees of freedom, therefore providing the surgeon with improved visualization, dexterity, and precision and thus allowing the surgeon to perform a nerve-sparing procedure, which is the preferred technique for patients with early diagnosis of prostate cancer. In addition, this procedure enhances quality-of-life outcomes, which is a major concern for patients undergoing management of prostate cancer.
Tulane Urology, which is the only approved fellowship training site in the entire Gulf South, has surgeons on the robotic team who not only provide this state-of-the-art procedure, but they also travel extensively throughout the country, sharing their expertise and their techniques, thus teaching others this robotic-assisted approach to surgery.
What is Laparoscopic Surgery?
Tulane Urology has a long history of performing laparoscopy, since 1991. Laparoscopy is a minimally invasive technique for performing major abdominal surgery through several tiny (0.5 to 1 cm) incisions instead of the large 12-inch incisions used in the past. Specifically, laparoscopy involves a high-resolution video camera so organs, such as kidneys, adrenals, prostate, and ureters, can be visualized then manipulated with instruments via these tiny abdominal incisions, which produce less discomfort compared to the large incisions required for open surgery. Furthermore, with laparoscopy, the need for pain medication, the length of hospital stay, and the recovery time are greatly reduced.
Benefits of Laparoscopic Surgery
- Less postoperative pain
- Less blood loss
- Less hospital stay
- Favorable cosmetic result / smaller scars
- Earlier return to work and normal activities
Laparoscopic surgery cannot be performed if you have:
- Uncorrectable coagulopathy
- Intestinal obstruction
- Abdominal wall infection
- Suspected malignant ascites
Also, relative contraindications include morbid obesity, extensive prior abdominal or pelvic surgery, ascites, pregnancy, severe chronic obstructive pulmonary disease (COPD), and severe cardiac arrhythmias or heart disease.
Complications are decreased in experienced surgeons who perform laparoscopy on a routine basis. The estimated complication rate of laparoscopic surgery is less than 5%. The associated mortality rate is about 0.3% and conversion rate was 1-5%. Risks of surgery include bleeding, infection, injury to adjacent organs, as well as possible conversion to open surgery. Conversion to open surgery may be necessary to safely complete the planned procedure, which occurs < 5% in experienced hands.
High-Intensity Focused Ultrasound, or HIFU, is a therapy that destroys tissue with rapid heat elevation, which essentially destroys the tissue. Ultrasound energy, or sound waves, is focused at a specific location, and at that “focal point,” the temperature raises to almost 90 degrees Celsius in a matter of seconds. Any tissue at the “focal point” is destroyed; however, any tissue outside of the focal point remains unharmed.
Patients who have been diagnosed with prostate cancer, or who have been previously treated with radiation therapy, may have recurrent prostate and may be candidates for HIFU treatment.
- Men with initial presentation of organ-confined recurrent prostate cancer (Clinical Stage T1c or T2a only) and who have been treated with external beam radiation.
- PSA less than10 ng/mL, greater than 0.5 ng/mL
- Negative bone scan
- Age 40 – 85 years old