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Traditional or robotic prostate surgery?"I present the choice very simply: either you are damaging the prostate or removing it," says Randy Fagin, who performs robot-assisted surgeries in Austin, Texas. "If you damage it and leave it there, what if the cancer comes back? If you have surgery, it's gone." Surgeries using the daVinci Robotic System now account for over 50% of prostatectomies. The surgeon sits at a console about six feet from the patient and, while watching on a video screen, manipulates miniature, flexible tools that perform the surgery through small incisions. It's minimally invasive, which reduces pain, recovery time and blood loss. Most patients go home the next day. "If you have a well-trained robotic surgeon, there's absolutely no reason to filet patients open and go through all the mess we used to have," says David Samadi, chief of robotic and minimally invasive surgery at Mount Sinai Medical Center in New York City who has performed over 1,800 robotic prostatectomies. Doctors who practice traditional "open" surgeries say there are no reliable studies showing that robotic surgery has higher cure rates or fewer side effects than conventional surgery. Both parts agree that having a highly experienced surgeon is far more important than the method he or she uses. How can patients find one? Jan Manarite, a counselor of the Prostate Cancer Research Institute, a nonprofit patient education group, suggests joining a local support group and asking for recommendations. "Some surgeons will also give you a list of their patients to talk to -- that's a sign of honesty and transparency," she says. Removing the prostate does carry a high risk of side effects, since many delicate nerves and blood vessels involved in urination and ejaculation run through the gland. Depending on where and how big the cancer is, surgeons may be able to use "nerve-sparing" procedures that preserve much of those functions. Most men need a urinary catheter for a week or two after surgery. Some need to wear absorbent pads for a few weeks, but most are fully continent within a year. Sexual function after surgery depends largely on the age of the patient, his potency before surgery and the skill of the surgeon. "Whatever you start out with, even in the hands of an artist, you will probably come away with a little bit less," Ms. Manarite says. NOTE: Issues on this site regarding prostate cancer and treatment options, are provided for information only, and are not meant to substitute for the advice of your own physician or other medical professional. Prostate-Report.org does not endorse any specific product, service or treatment. |
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