Advanced Robotic Prostate Surgery in India

A boon for Prostate Cancer patients - Advanced Robotic Prostate Surgery is now preferred choice for Prostate Cancer patients due to following Unmatched advantages

• Minimal Bleeding
• Much quicker recovery
• Reduced hospital stay
• Lesser pain killer requirements
• Lower blood transfusion rates
• Improved preservation of physical appearance
• Three (3) D vision enables surgeon to perform Prostate excision with Cancer
• Control without risk of Post Surgery Continence (control over urinary and
• fecal discharge) and causing Impotency

What is Da Vinci master slave Robotic System?

Da Vinci master slave robotic system is used to completely eradicate cancer with minimal side effects for treating Prostate Cancer. Through this system a minimally invasive robot assisted radical prostatectomy technique has been developed in which doctors evolved a unique sequence of surgical steps.

The Da Vinci is a sophisticated master-slave robot that incorporates 3-D high definition visualization, scaling of movement, and wristed instrumentation. The operations with the Da Vinci System are performed with no direct mechanical connection between the surgeon and the patient. The surgeon is working a few feet away from the operating table, while seated at a computer console with a three-dimensional view of the operating field.

 How it is  performed ?

Robotic Prostatectomy, also known as Robotic surgery for prostate cancer or da Vinci Prostatectomy is a minimally invasive surgery that is now the preferred approach for removal of the prostate in those diagnosed with organ-confined prostate cancer. The da Vinci Prostatectomy may be the most effective, least invasive prostate surgery performed today. Though any diagnosis of cancer can be traumatic, the good news is that if your doctor recommends prostate surgery, the cancer was probably caught early. And, with da Vinci Prostatectomy, the likelihood of a complete recovery from prostate cancer without long-term side effects is, for most patients, better than it has ever been.

The operation is performed using the daVinci Surgical system and 3-D endoscopic and wristed instruments inserted through 5-6 small incisions across the mid-abdomen

UnbeatableAdvantages of Robotic Prostate Surgery over the Conventional Prostate Cancer Surgery
1) Usually in conventional approach, surgeons make decisions using tactile and visual cues to identify a phenomenon, which is actually microscopic which is likely to damage nerves or to leave cancer behind. In the Advanced Robotic Technique (ART) surgeons uses a sophisticated mastr slave robot that incorporates 3-D high definition vision, scaling of movement and wristed instrumentation that gives him the ability to perform Prostate excision with minimal risk of leaving the cancer behind and also minimal bleeding and post operative risk of incontinence and impotence.

2) Neither clinical nor imaging tests are sensitive enough to capture a tumour at T3 stage where it has become locally advanced and a risk for spreading to other body parts. Sometimes it is difficult for surgeons to find a precise plane between the cancer and urinary sphincter or the nerves and err on the side of cancer safety leading to incontinence or Impotence Da vinci robot system minimizes side effects thereby greater control for the patient over urinary discharge i.e. continence and return to normal sexual function after the surgery.

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Prostate Cancer - Alternative Cancer Treatments in India

The prostate is a walnut-sized gland in the male reproductive system that helps in formation and storage of seminal fluid. The prostate gland in a male body is located in pelvis under the urinary bladder  and in front of the rectum. In simple words we can define and understand Prostate cancer as one which is mainly associated with urinary dysfunction

Prostate cancer tends to develop in men over the age of fifty and very uncommon in men younger than 45 but becomes often common with the men of advancing age. As of 2011, prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males worldwide.

 Signs and Symptoms:-

 Early prostate cancer usually causes no symptoms because most of the prostate cancers are slow growing however, there are cases of aggressive prostate cancers with following symptoms:-

·         Frequent urination,

·         Nocturia (increased urination at night)

·         Hematuria (blood in the urine)

·         Dysuria (painful urination)

·         Difficulty in starting and maintaining a steady stream of urine

·         Loss of weight and appetite, fatigue, nausea, or vomiting

·         Weakness or paralysis in the lower limbs

   

Diagnosis:-

• Prostate-Specific Antigen (PSA) Test : A blood sample is drawn from a vein in your arm and analyzed for PSA, a substance that's naturally produced by your prostate gland. It's normal for a small amount of PSA to be in your bloodstream but if the value increases, the cause must be located.
• Ultrasound : If other tests raise concerns, your doctor may use transrectal ultrasound to further evaluate your prostate. This gives a clear picture of the prostate gland.
• Bone Scans and X-rays : It may reveal whether the cancer has invaded the bones. To perform a bone scan, doctors inject low doses of a radioactive substance into the patient's vein, which accumulates in bones that have been damaged by cancer.
• Digital Rectal Exam (DRE): During a DRE, your doctor inserts a gloved, lubricated finger into your rectum to examine your prostate, which is adjacent to the rectum. It helps to detect any structural anomalies in the prostate.
• Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Scans : They can further pinpoint the location of cancer that has spread beyond the prostate.
• Biopsy : The removal of cells or tissues so they can be viewed under a microscope by a pathologist. The pathologist will check the biopsy sample to see if there are cancer cells and find out the Gleason score.

    Treatment for Prostate Cancer :-

·         Active surveillance:- It refers to the process of observation and regular monitoring and it               can be used effectively when prostate cancer is suspected in its early stage. It includes PSA blood tests and prostate biopsies.   

·         Surgery:- prostatectomy i.e Surgical removal of the prostate. It is most common mode of treatment either for early stage prostate cancer or for aggressive prostate cancer cases. It involves the two major kinds of radical prostatectomy those are radical perineal prostatectomy, and radical retropubic prostatectomy.       

·         Cryosurgery:- It is yet another method of the  treatment of prostate  cancer in which the prostate gland is exposed to freezing temperatures.

·         Radiation therapy:- It is also known as radiotherapy which is used  in the treatment of all  stages of  prostate cancer patients. There are two different kinds of radiation therapy used: external beam radiation therapy and brachytherapy . Brachytherapy involves the surgical placement of radioactive seeds or implants directly into the cancerous portions of the prostate where the radiation kills the available cancerous cells.

·   Advanced Robotic Prostate Surgery  is now preferred choice for Prostate Cancer patients due to following unmatched advantages:-

•  Minimal Bleeding
• Much quicker recovery
• Reduced hospital stay
• Lesser pain killer requirements
• Improved preservation of physical appearance
• Three (3) D vision enables surgeon to perform Prostate excision with Cancer
• Control without risk of Post Surgery Continence (control over urinary and fecal discharge) and causing Impotency

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Pros and Cons of HIFU Prostate Cancer Treatment in India

HIFU prostate cancer treatment is one of the most rapidly growing treatment methods around the world.

Prostate cancer is one of the most common forms of cancer in men. In the early stages, medication might be used to treat the condition. However, if the cancer tumor spreads, then surgery might be needed.

People dread going for surgery as there are notorious side effects like impotence and urinary incontinence associated with prostate cancer surgeries. But with the introduction of HIFU, things have changed.

HIFU stands for High Intensity Focused Ultrasound. The advantage of using HIFU prostate cancer treatment is that it is very precise and does not come with side effects like with traditional surgery procedures. In this treatment method, high intensity ultrasound waves are used to destroy the cancer cells.

Pros and Cons of HIFU Prostate Cancer Treatment:

Ultrasound waves are focused on the diseased location. The temperature at that location rises up to 90 degree celcius in just a few seconds time. This rapid heating causes the cancer cells to be burned up and destroyed. The success rate of HIFU prostate cancer treatment is similar to other surgeries, but. That is the reason for the suddenly rising popularity of this treatment method.

The patient will not require very long hospital stay. In most cases, he can walk out the same day the operation is performed. In HIFU prostate cancer treatment, the patient is given local anesthetic and then a probe is inserted through his anus. The whole process takes anywhere from 2 to 4 hours. At the end of this, the patient can walk out of the hospital without the enlarged prostate.

However, there are certain downsides to HIFU prostate cancer treatment. First of all, it is very costly. So everybody cannot afford it. Secondly, only those patients can be treated whose cancer has not spread outside of the prostate gland. Another drawback is that this treatment is relatively new and there is not much statistical data yet on its long term success. Although the results published so far have been very promising, there might be some side effects which have not come to light as yet.

For this reason, HIFU prostate cancer treatment is not yet approved in United States by the FDA. It is however approved in various other countries like China, Japan, Mexico, European nations etc. It may take another few years before FDA finally agrees to allow this treatment in USA.

Quite often, patients successfully treated with HIFU might not have required any surgery at all. They might have been perfect candidates for ‘watchful waiting’, in which doctors wait and carefully monitor the growth of prostate cancer before beginning treatment.

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What are the advantages of a laser prostatectomy? What are the alternatives to GreenLight PVP laser prostatectomy

Why have a laser prostatectomy?

The reasons are the same as for a TURP, which are:

• urinary symptoms due to an enlarged prostate (BPH) that are bothersome and are not adequately improved by medicines, changing one's lifestyle
• urinary symptoms due to BPH that are bothersome and cannot be treated by drugs or other minimally invasive techniques
• urinary symptoms due to BPH proven to be due to bladder outlet obstruction on urodynamics with a desire to remove obstruction in order to avoid long term problems of bladder outlet obstruction
• The inability to pass urine without a catheter ('urinary retention')
• kidneys that are not functioning properly because the prostate is blocking the bladder
• recurrent urine infections due to obstruction caused by the prostate
• bleeding from the prostate due its enlargement (BPH), which may not have improved with a 5-alpha reductase inhibitor like finasteride or dutasteride
• prostate cancer ('channel TURP'): this is to allow urine to flow and is not intended to be curative

In addition, the treatment can be performed in patients who have abnormal clotting or are on drug thinners (e.g. aspirin, warfarin etc) in certain cases.

What are the advantages of a laser prostatectomy?

Urinary symptoms are reduced as much as for traditional surgery and significantly more than with the use of medication. In addition, there is shorter stay in hospital, shorter period or no catheterisation and less blood loss. There is much less bleeding, which is why the procedure can be performed on men taking aspirin.

The instrumentation for a laser prostatectomy is smaller than that used for a TURP, so, in theory, there should be a reduced chance of a urethral stricture.

Saline is used during the procedure to irrigate the area, and this is safer than the irrigation used to a TURP that can cause a rare but dangerous problem known as TUR syndrome.

How well does a laser prostatectomy work?

The GreenLight PVP works as well as TURP for small or moderate sized prostates. Providing men have bladder outlet obstruction, 9 in 10 men should experience a significant improvement in urinary symptoms after laser prostatectomy. Patients who had a catheter in should be able to pass urine with little problem.

What are the alternatives to GreenLight PVP laser prostatectomy

There are several procedures of which the most common are listed below.

• Transurethral Needle Ablation (TUNA) of the prostate: this is a less invasive procedure than laser prostatectomy, can be performed in day surgery or as an outpatient, with fewer problems and maintains normal ejaculation. Symptoms are improved after TUNA, but not quite as much as after laser prostatectomy.
• TURP: This is the gold standard treatment for BPH by which other treatments are judged. Compared to laser prostatectomy, There is more blood loss and a greater chance of needing a blood transfusion, a longer hospital stay and more post operative complication. There is less discomfort felt in the bladder and penis after this compared to laser prostatectomy and usually there is no slough to pass.
• Open prostatectomy: For this, an incision is made in the lower abdomen under general anaesthetic or when the skin is made numb from the waist down, and the prostate removed. Urinary symptoms are improved possibly slightly better than laser prostatectomy. A prolonged hospital stay is required and bleeding can occur sometimes requiring a blood transfusion. This option is reserved for very large prostates that are usually too large to be treated by one of the other options.
• Prostate stent: This is usually reserved for patients who are unsuitable for any other form of therapy. It is performed in day surgery, involves local anaesthesia, but is less effective than the other options.
• Transurethral Microwave Thermotherapy (TUMT): this is another minimally invasive option that works well in selected patients but still results in retrograde ejaculation.
  
  
  
  

Robotic Surgery for Prostate Cancer : Advantages over Both Open and Laparoscopic Prostate Cancer Surgery

The technology offers a number of other advantages over both open and laparoscopic surgery. It is a much less invasive form of surgery than open surgery, resulting in a shorter hospital stay and quicker recovery time, while patients experience reduced blood loss during surgery and reduced post-operative pain as smaller incisions are required. In addition there is much less need for blood transfusion and there is a lower risk of wound infection.

 It provides the specialist with far superior three-dimensional, high definition visualisation of the prostate, surrounding tissue and neurovascular bundles than is possible with open or laparoscopic surgery. It allows the surgeon improved dexterity and a steadier ‘hand’ when performing the procedure.

The technology translates the surgeon’s hand movements on the instruments on the console into corresponding movements of the robotic arm instruments inside the patient, which gives the surgeon excellent control in performing a wide range of motions.The robotic technology is a much-needed addition to the armoury in the fight against prostate cancer as it offers patients who require a radical prostatectomy a treatment option that delivers better outcomes.

Worldwide increase in robotic surgery

Worldwide, the da Vinci system is being used in an ever increasing number of different procedures. To date it has mainly been used in the field of urology to perform prostatectomies to treat prostate cancer, a procedure that requires great surgical precision.

Some 80% of prostatectomies in US are now being performed robotically, and the number of procedures completed with such technology is increasing significantly year-on-year throughout the world.

World’sMost Advanced Robotic Surgery for Prostate Cancer

A boon for Prostate Cancer patients – Advanced Robotic Prostate Surgery is now preferred choice for Prostate Cancer patients due to following unmatched advantages

• Minimal Bleeding
• Much quicker recovery
• Reduced hospital stay
• Lesser pain killer requirements
• Lower blood transfusion rates
• Improved preservation of physical appearance
• Three (3) D vision enables surgeon to perform Prostate excision with Cancer
• Control without risk of Post Surgery Continence (control over urinary and
• fecal discharge) and causing Impotency

What is Da Vinci master slave Robotic System?

The surgical application of robotic systems is one of the most exciting and significant technological developments of this century; its future implications are incalculable.Huge strides have been made in the field of closed operations in the past 10 years and the use of robotic systems has emerged as the principle solution to technical limitations|

The use of robotic surgical systems has numerous advantages. Whereas modern laparoscopic systems give only a two-dimensional vision, robotic systems give the surgeon a three-dimensional field of vision and depth, provide arms that, unlike the human hand, never tire and permit an unprecedented continuityin operations. Since robotic systemsexceed even the human hand’s freedom and facility of movement, far greater delicacy and dexterity is achieved. Modern robotic systems fall into three categories; active, semi-active and master-slave.But the most commonly used are master-slave systems distinguished by the surgeon’s absolute control of the robot via a remote control console.

The Da Vinci is a sophisticated master-slave robot that incorporates 3-D high definition visualization, scaling of movement, and wristed instrumentation. The operations with the Da Vinci System are performed with no direct mechanical connection between the surgeon and the patient. The surgeon is working a few feet away from the operating table, while seated at a computer console with a three-dimensional view of the operating field.

UnbeatableAdvantages of Robotic Prostate Surgery over the Conventional Prostate CancerSurgery

1) Usually in conventional approach, surgeons make decisions using tactile and visual cues to identify a phenomenon, which is actually microscopic which is likely to damage nerves or to leave cancer behind. In the Advanced Robotic Technique (ART) surgeons uses a sophisticated mastr slave robot that incorporates 3-D high definition vision, scaling of movement and wristed instrumentation that gives him the ability to perform Prostate excision with minimal risk of leaving the cancer behind and also minimal bleeding and post operative risk of incontinence and impotence.

2) Neither clinical nor imaging tests are sensitive enough to capture a tumour at T3 stage where it has become locally advanced and a risk for spreading to other body parts. Sometimes it is difficult for surgeons to find a precise plane between the cancer and urinary sphincter or the nerves and err on the side of cancer safety leading to incontinence or Impotence Da vinci robot system minimizes side effects thereby greater control for the patient over urinary discharge i.e. continence and return to normal sexual function after the surgery.

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