Robotic Radical Prostatectomy
Dr Gianduzzo is one of Australia's most experienced robotic prostatectomy surgeons and has been performing key-hole (laparoscopic and robotic) prostate surgery since 2004. He has completed a master's thesis on advances in robotic prostatectomy, which included robotic instrument design and development with Intuitive Surgical (www.intuitivesurgical.com) the robotic manufacturing company. Dr Gianduzzo recieved iternational fellowship training in key-hole prostate surgery in both the UK and at the Cleveland Clinic, USA. International training in radical prostatectomy is known to improve operative outcomes. At the 2010 Urological Society of Australia and New Zealand Annual Scientific Meeting, his results of Laparoscopic Radical Prostatectomy were presented in conjunction with Dr Charles Chabert from the Gold Coast. The positive margin rate of 1.1% for disease confined to the prostate, compared favourably to international radical prostatectomy series. Most recently Dr Gianduzzo and Dr Chabert published their results of Robotic Radical Prostatectomy which reported no positive margins (i.e. 0%) for organ confined disease (Wolanski P, Chabert C, Jones L, Mullavey T, Walsh S, Gianduzzo T. Preliminary results of robot-assisted laparoscopic radical prostatectomy (RALP) after fellowship training and experience in laparoscopic radical prostatectomy (LRP). BJU Int. 2012 Dec;110 Suppl 4:64-70. - www.ncbi.nlm.nih.gov/pubmed/23194128).
The main outcomes of radical prostatectomy are
- Negative surgical margins
- Potency (erection and intercourse) rates
- Continence (pad free) rates
Positive surgical margins
When the prostate is removed it is covered in ink to mark where the surgeon has cut. It is then examined under the microscope. If cancer cells touch the ink, then this may indicate that not all of the cancer has been cleared and some has been left behind. This is termed a positive margin. If cancer cells are not touching the ink then this is a negative margin. The first aim of radical prostatectomy, before any other, is to achieve a negative margin. If the cancer has extended outside of the prostate gland into the adjacent tissue then the chance of a positive margin increases. However, in cases where the cancer is confined to the prostate gland, the positive margin rate should be very low as, apart from some rare exceptions, it generally only occurs when the surgeon accidentally cuts into the prostate. For disease confined to the prostate Drs Gianduzzo and Chabert reported a positive margin rate of 1.1% in their laparoscopic series, while for their robotic series, there were no positive margins (0%). The following table compares their results to that of contemporaneous international literature.
Positive Surgical Margins of published international series of Open, Laparoscopic and Robotic Radical Prostatectomy:
|Laparoscopic Prostatectomy*||Gianduzzo and Chabert Laparosocpic Prostatectomy||Robotic Prostatectomy*||Gianduzzo
and Chabert Robotic Prostatectomy†
|Positive Margin Rate||2.3-16.8%||1.1%||2.5-22%||0%||6%-36.7%|
* Berryhill et al. Urology 2008, 72:15-23
† BJU Int. 2012 Dec;110 Suppl 4:64-70.
Erections and urinary control
In our series, the number of patients recovering their erections (potency) and their urinary control (continence) also compares favourably to the published international literature. We reported a pad free rate at 12 months after the operation of 95% and an intercourse rate of 83% at 12 months in men in whom both nerves have been spared and who had normal erections prior to surgery. Despite this it is important to note that both your waterworks and your erections will take a hit from surgery, irrespective of how, or by whom, your surgery is done.