The term prostate cancer - what comes to mind?

In the early days, a prostate cancer diagnoses would often come too late. When surgery became an option, it was an attempt to go in, rip out everything, and be done with it. This left too many men incontinent and impotent - permanently. Some doctors even dismissed the fact that older guys wished to continue to, well, go to the bathroom normally and have sex. During those years - and even today - a prostate cancer diagnosis brought visions of drooling, dribbling old men.

Newer surgical techniques, including a robot called da Vinci are changing the prognosis. Nerve-sparing technologies were the first to arrive on the scene. Surgeons could literally cut out the prostate and save one or both "nerve bundles." It is those nerves that control healthy sexual function. Now, it's also possible to graft the nerves. In addition, the sphincter muscles can also be salvaged, leaving room for a reasonable, if not complete, return to continence. A very exciting turn, considering that prostate cancer is the second highest killer of men, right behind lung cancer.

When the da Vinci robotic machine from Intuitive Surgical® came on the scene in 1999, it had many years of testing under its belt. It quickly became approved to act as a responsive and more precise laparoscope. Today, da Vinci machines in hospital specialty units are guided by highly trained surgeons for heart procedures (mitral valve in particular), hysterectomies, and that male nemesis - the prostate gland gone bad.

How the da Vinci® System works

A da Vinci prostatectomy is termed a "minimally invasive procedure," as are laparoscopic surgeries. There is little blood loss, most patients experience less pain, and recuperative time is usually short as opposed to open surgeries. The hospital stay is typically 24-36 hours and the patient goes home. It is a major surgery, nonetheless, and requires the greatest skill to sever the gland that grows attached to - or lies near - so many important muscles and tissues.

The most amazing part of this machine is that the surgeon operates, not on the patient, but at a console some distance from the surgical field. Highly trained assistants including the anesthetist are grouped around the bed. From the console, the surgeon controls "Scissorhand" type fingers - plus a camera - that enter through five small abdominal incisions and do their work. Each movement is precisely orchestrated with "joysticks" and a great amount of skill as the surgeon's hand movements perform as if directly inside the patient. The robot cannot think on its own nor is it programmed. Even in the case of a "wrong turn" by the surgeon, the robotic fingers move in such small increments and with a slightest delay, that instant correction is possible. The 3-D viewing field is magnified many times over so the surgeon is able to perform in the tiniest increments.

It's more complicated than that, of course, and immense skill is required. Since the urethra runs directly through the prostate gland itself, a portion of this tube is sectioned off, along the gland. Once the prostate leaves the body in a small "baggie" near the navel, the two urethra ends are reattached. It is this healing process that may lead to varying amounts of incontinence during recovery. To make things easier, a catheter is inserted during the surgery. For a week or so, patients will wear an attached bag to collect urine. Following the catheter removal, many men wear protective pads for as little as a day or even a few months. Control is generally regained - at the outside - within a year.

Aggressive prostate specialists also begin men on a potency regime as well. This can include such drugs as Cialis, Viagra, and Levitra. The intent is to get blood flowing to the penis and regaining full - or close to it - sexual function. Post-surgery functions can be achieved that are equal to those of pre-prostate removal. When both nerve bundles are spared, this can make for a quicker recovery. Shots, suppositories and pumps may also be recommended as part of the rehabilitation.

Not everyone is a candidate for a da Vinci prostatectomy

Currently, there are some indications that previous abdominal surgeries may prohibit any prostatectomy. Adhesions, or scarring buildup, can leave a less clear viewing field. However, many top-rated surgeons are now successfully performing da Vinci procedures in spite of these issues.

The extent of prostate cancer itself is also a determining factor. If the cancer appears to have spread into lymph nodes, for instance, an open procedure may be a wiser choice at present. The robot is proficient at removing the gland itself, but a surgeon's feel and touch may be better at detaching lymph nodes and making a more extensive sweep of the area.

Non-related medical conditions and age are also factors, of course, as they are with any surgery. However, this is not a catchall statement and each surgeon will have different criteria for performing a da Vinci prostatectomy. Also, the medical field is realizing that many older men are living well, and actively, into their nineties. They are now beginning to see that a healthy individual at any age may benefit from this amazing robot for prostate cancer treatment.