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This video clip is about radical prostatectomy,
which is the most common form of definitive prostate cancer therapy.
Radical prostatectomy means completely removing the prostate by surgical means.
Traditionally this is done by cutting from the umbilicus to the pelvic bone.
The prostate is entirely removed along with the seminal vesicle.
In most cases the nerve fibers responsible for *** can be conserved.
Lymph nodes possibly infected with cancer are removed as well.
Subsequently the bladder and the urethra are joined with the thinnest thread.
We introduce a catheter, which normally stays in place for 1-2 weeks.
There are two major advantages to radical prostatectomy.
First: the prostate carcinoma is removed completely
Second: We obtain vital information regarding the cancer itself.
Once we know if the tumor has already breached the prostatic capsule or infiltrated lymph nodes,
we can start a potentially necessary follow-up therapy promptly and effectively.
As with any kind of therapy there are risks involved.
They concern continence and potency.
The bladder's sphincter is situated directly in front of the prostate.
Whether full functionality can be preserved,
depends largely on the surgeon's skills and the patient's age.
This urinary incontinence typically resolves itself,
once the healing process is complete, within 6-24 weeks.
3-6 months after surgery, only 2% of our own patients occasionally lose urine.
So ask your surgeon before undergoing the procedure about the rate of incontinence with his patients.
The prostate produces seminal fluid.
So once the prostate is removed there is no seminal discharge anymore.
However, men will still experience a normal ***.
The nerves responsible for *** are in direct contact with the prostate.
Therefore, nerve impairment can never be ruled out completely, not even using the greatest diligence.
Regeneration time necessary and quality of ***
largely depend on the patients' age and their risk potential.
PDE5 inhibitors such as ***, Cialis and Levitra may be used for support.
This is where the Kiel concept comes into play:
Post surgery patients receive low doses of PDE5 inhibitors for several months,
boosting the ***' oxygen supply and improving erectile function.
Nowadays the majority of radical prostectomy cases
is no longer done as open surgery, but with robotic assistance.
Robotically assisted da Vinci surgery is probably the greatest surgical innovation within the last 20 years,
and it is replacing traditional surgery more and more.
The tiny instruments are introduced into the human body through miniscule incisions.
Then, sitting at the console, the surgeon takes control.
Da Vinci's instruments are extremely agile,
any movement performed by the surgeon's hands are directly transferred.
Additionally da Vinci is equipped with a stereoscopic camera,
providing surgeons with an enlarged 3D HD image.
It's as if doctors had been miniaturized and beamed into the patient's body.
This allows for procedures previously deemed impossible.
In regard to prostate cancer this has extremely positive effects on nerve conservation.
Our clinic in Kiel features a special kind of intraoperative diagnostics.
The prostate is separated completely from bladder and urethra and extracted.
Then pathologists chop entire slices off the front and back
and examine them while the procedure is still in progress.
Traditionally only one isolated sample is taken.
Kiel's Onko|Safe-concept
uses entire slices cut from the prostate's rim
which are histologically examined.
This ensures a maximum of certainty
in removing any and all cancer cells.
Comparing standard intraoprative diagnostics to final histological results
shows an 83-87% accuracy rate.
Kiel's Onko|Safe method has a 95% accuracy rate.
There's one more advantage to da Vinci-surgery
in cases of extended lymphadenectomy,
which is necessary in all patients who have a Gleason Score of 7b and above.
Robotically assisted surgery
allows for a more precise and more extensive removal of lymph nodes
with reduced side-effects.
Finally, let's take a comparative look at traditional vs robotically assisted prostatectomy:
Da Vinci uses tiny incisions for access, instead of a lengthy abdominal section.
The catheter can be removed earlier,
nerve conservation is improved,
there is less blood loss, reduced pain,
and faster recuperation.
Lymph node removal can be more extensive,
more accurate,
and has fewer side effects.
With this new technology continence and erectile function
after surgical removal of the prostate are excellent.
To me personally the robotically assisted da Vinci prostatectomy
is the best available treatment option for prostate cancer.