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PLME > Robotic Surgery > Flashcards

Robotic Surgery Flashcards

1
Q

what is the prostate?

A
  • male sexual gland
  • adds nutrients and fluids for sperm
  • this fluid is added to sperm during ejaculation
  • urethra (urine channel) runs through the middle of the prostate
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2
Q

what is prostate cancer?

A
  • abnormal cells growing out of control
  • spreads and invades local tissues
  • prostate cancer
  • begins with a small tumor in the gland
  • first spreads to the local lymph nodes
  • then spreads to the bony skeleton and other areas of the body
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3
Q

Prostate Cancer Facts

A

prostate cancer
-leading type of cancer in men
-second leading cause of death in American males
-over 30k deaths each year in U.S
early detection
-best prognosis is early detection
-recent data on lower mortality rates of prostate cancer (40% reduction in mortality over last 30 yrs)
-affords patients many options for treatment

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4
Q

what is the relationship between prostate cancer and race?

A

incidence and mortality rate are higher in black than white

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5
Q

what are some early detection methods?

A
  • digital rectal exam
  • prostate specific antigen blood test (PSA)
  • any abnormality in the PSA or DRE will require
  • biopsy of the prostate
  • ultrasound guided
  • usually performed in the office
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6
Q

biopsy results

A
  • prostate cancer graded on appearance of cancer cells
  • gleason grading system
  • gleason grade ranges from 1 (least aggressive) to 5 (most aggressive)
  • gleason score (2-10)
  • most common cell grade (first) added to second most common cell grade
  • i.e Gleason 7 (3+4)
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7
Q

what do treatment options depend on?

A
  • stage of disease
  • patient’s age and health (comorbidities)
  • patient’s personal preference
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8
Q

what are the treatment options (early diagnosis)?

A
  • watchful waiting
  • external beam radiation therapy
  • brachytherapy (radioactive seeds)
  • cryosurgery (freezing prostate)
  • surgery (radical prostatectomy)
  • open prostatectomy
  • conventional laparoscopic surgery
  • robotic assisted prostatectomy
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9
Q

robotic surgery

A
  • allows for minimally invasive therapy GU malignancies
  • less blood loss
  • quicker convalescence and return to daily routine
  • equivalent cancer control
  • reduces the comorbidities associated with prostate surgery (i.e. continence and potency)
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10
Q

who is a candidate for robotics?

A
  • men age 40-70 with localized prostate cancer
  • no evidence of metastatic disease on evaluation
  • prior abnormal surgery is a relative contraindication:
  • AAA or prior aorto-bifemoral bypass
  • complex colorectal surgery (LAR, APR, diverticular abscess, colostomies)
  • prior prostate surgery or pelvic XRT
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11
Q

what are the goals of radical prostatectomy?

A
  • remove the prostate and cancer
  • high cure rates for localized disease
  • preserve urinary function
  • preserve erectile function
  • analyze the prostate after surgery to assess risk of recurrence of cancer
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12
Q

nerve-sparing prostatectomy

A
  • preserves nerves responsible for erections
  • nerves run alongside prostate
  • the da vinci system permits surgeon to spare nerves
  • superior visualization
  • high resolution 3-D image
  • endowrist instruments
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13
Q

laparoscopic surgery

A
  • minimally invasive surgery
  • ability to operate through small keyhole incisions
  • camera and instruments fit through the keyhole incisions
  • better visualization than open surgery
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14
Q

conventional laparoscopic surgery drawbacks

A
  • 2-D flat image video
  • rigid instruments- chopsticks
  • instruments controlled at a distance- fulcrum effect
  • decreases your surgeon’s precision, dexterity and control
  • higher surgeon fatigue
  • makes complex operations more difficult
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15
Q

how does robotics overcome the drawbacks?

A
  • provide a high resolution 3-D color image
  • interpose a computer between the surgeon’s hand and the instrument tip
  • increase the surgeon’s dexterity for the difficult aspects of the procedure
  • sparing the nerves to preserve erectile function
  • preserving continence
  • preserving quality of life
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16
Q

what is the da vinci surgical system?

A
  • powered by state-of-the-art robotic technology
  • surgeon is in control and operates at the console
  • assistant surgeon is next to the patient
17
Q

vision system

A

*surgeon is immerse in 3-dimensional image of the surgical field

18
Q

the surgeon directs the instruments

A

*the surgeon’s hands are placed in special devices called masters that direct the precise instrument movements

19
Q

wrist and finger movement

A
  • traditional laparoscopic instruments are straight and do not bend
  • endowrist instruments move like a human wrist
  • allows increased dexterity, maneuverability, and precision
20
Q

small instruments through keyhole incisions

A
  • da vinci surgical system endowrist instruments are small and are able to fit through keyhole incisions
  • a wide range of instruments are available
21
Q

what are the benefits of da Vinci prostatectomy?

A
  • decreased blood loss
  • shortened length of hospital stay
  • decreased postoperative pain
  • less scarring
  • shorter urinary catheter time
  • faster return to regular activities
  • anticipation of improved potency and continence
22
Q

what are the differences between robotic-assisted surgery and the traditional open procedure?

A
  • in the open procedure, we have to make a long incision down the center of the abdomen
  • in the robotic-assisted procedure, we make several small “key hole” incisions. these access points allow us to insert a high-powered 3-dimensional camera as well as robotic instruments into the abdomen. We can now see, under high-magnification, the prostate and surrounding anatomy. we can then perform a precise & delicate operation with the robotic instruments
23
Q

compare the benefits of the two procedures

A 
open procedure
*long incision
*hospital stay of 3.5 days
*blood loss 900 mL
*catheter removal 14 to 21 days
robotic-assisted procedure
*5 or 6 small keyhole incisions
*hospital stay of 1.2 days
*blood loss 153 mL
*catheter days 5 to 7 days
24
Q

what are some potential complications?

A
  • essentially the same as with open prostatectomy
  • greatest difference is that an open prostatectomy is performed retroperitoneal
  • while robotic and lap are intraperitoneal

PLME (5 decks)

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