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So what goals does a robotic surgeon have for his patient when he embarks on the surgical
procedure itself.
There are a number of goals that we as robotic surgeons have when we go in to do a robotic
surgery. First and foremost is curing the patient of their disease. Unfortunately, to
the naked eye, prostate cancer looks very similar to normal tissue and when we do this
surgery, you don't see a great demarcation between cancer tissue and normal tissue, but
the ultimate goal of robotic surgery is to get all the cancer out and have negative margins.
In patients that have more extensive disease, if we believe the disease is outside the prostate,
as surgeons we can swing the margins a little wider to make sure that we get negative margins.
In some ways, robotic surgeons' eyes become their hands. When we do open surgery, we are
allowed to feel tumors that are palpable. With robotic surgery, you don't have that
sensation of being able to palpate things, so your eyes become your hands and are able
to see where things are, if you see differences in tissue colors and size and so forth, you
may want to swing a margin out little wider to ensure that you get a negative margin.
We would like to try to preserve the neurovascular bundles when we do the surgery. We know that
the nerves that supply the *** for *** run alongside the prostate and we can peel
those nerves off like peeling an onion skin off an onion and typically what we like to
see is, we like to see two bundles after we have taken the prostate out in the prostatic
bed to represent where those neurovascular bundles are. Now only do we believe that that
is important for erectile dysfunction and erectile function going forward but there
may be some link to incontinence. We would like to see a nice stump of the urethra and
the nice small opening of the bladder neck and those are important because I think those
help with urinary continence. So as a surgeon, what we like to do is, one, make sure that
we cure the cancer, two, we would like to see some anatomical landmarks of where we
know those nerves are and three, we would like to see a good long stump and a very small
bladder neck to sew things back together because we believe that all those factors may have
some impact on urinary continence in patients going forward.
Some prostate cancers are high risk, aggressive, and more likely to spread. Others are low
risk, least likely to have bad outcomes. The biopsy says cancer, but current diagnostic
tools provide limited information about how aggressive a man's individual disease is,
so most men decide to treat prostate cancer immediately. Once treated, many men experience
serious long-term side effects like incontinence and *** impotence. Immediate treatment
is not always needed, but right now a man can't be sure if his cancer is the kind that
is likely to require treatment or if he is okay to wait for now. What if there was a
test that could determine how aggressive prostate cancer is. Genomic health is developing a
new test to do just that. By reviewing the underlying biology of the tumor and using
genes from multiple biologic pathways, the test can predict the aggressiveness of prostate
cancer when diagnosed, allowing a man to make a more informed treatment decision with confidence,
taking care of himself with more information and greater peace of mind.