Tip:
Highlight text to annotate it
X
There are two good procedures that are
available for men who have prostate cancer.
And chosen to undergo prostate cancer surgery.
The first approach is open radical prostatectomy.
This approach was first described here at Johns Hopkins hospital and
has been perfected over the last 30 years by Dr. Patrick Walsh.
Building on the principles that Dr. Walsh
has initially described and continually builds on.
We have now employed those techniques in the robotic approach.
The procedures differ in the size and the location of the incision.
With open radical prostatectomy there's a small incision
that's below the belly button, along the midline.
With the laparoscopic robotic approach, there are several, about six, in small
incisions at the level of the belly button transversely across the abdominal wall.
For patients who choose either approach at Johns Hopkins
Hospital, they are on the same clinical critical pathway.
They stay in the hospital for one or two nights.
The duration of the catheter is about one week.
Patients are off of work about the same amount of time.
In some, there are no major significant differences in the perioperative
recovery between open radical prostatectomy
and laparoscopic robotic assisted radical prostatectomy.
For the most part, most men are,
are excellent candidates for either surgical approach.
However, there are specific instances where I
do not recommend one or the other approach.
Men who have had significant prior abdominal surgery and or who have high
risk prostate cancer, I generally recommend open
prostate surgery over the laparoscopic robotic approach.
Individuals who are obese and or have had prior laparoscopic mesh hernia
repairs, I generally recommend robotic approaches
over the open radical prostatectomy approach.
The the robotic approach offers an advantage of increased magnification
that allows the surgeon to see the, the surgical field better.
The disadvantage of the robotic approach is that there's no haptic feedback.
What I mean by that is that there's no ability to touch the tissue.
I think that this, this is a key difference, and
for individuals who have palpable prostate cancer, that is that
they have an abnormality on their *** exam, this does
play a role in how their operation can be performed.
It's in those situations I'd advise against a robotic
approach and recommend an open radical prostatectomy because if you
can feel the cancer on *** exam, you're going to
want your surgeon to feel the cancer during the operation.
One of the important considerations for a patient, once they've decided
to have their prostate removed is, where it's gonna be removed.
And I always recommend to, to my patients and people I'm
consulting, that they have their operation at a comprehensive cancer center.
Comprehensive cancer centers perform large volumes of these procedures.
The critical pathway in the recovery is streamlined.
The nurses who take care of these
patients, they recognize what procedure they've had.
They're very comfortable taking care of patients
who have had this procedure after the operation.
And that makes a big difference.
[NOISE] In the recovery for the patients.
[BLANK_AUDIO]