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| source - www.newbernsj.com |
Urology-related robotic surgery is a huge benefit to patients who previously would have had to undergo open surgery with its long incisions and long hospital stays, said Dr. Hoyt B. Doak IV of CarolinaEast Urology in New Bern.
“For us that’s a really big deal, to be able to avoid a big open incision,” said Doak, who has been doing robotic surgeries for seven years, with five of those years at CarolinaEast Medical Center.
While surgeons in other specialties could be doing some surgeries robotically, laparoscopically or open, those in urology essentially have only two choices – robotic or open, he said.
“The cases that we do in urology are cases that are mostly just too technically difficult to be done laparoscopically,” Doak said. “They require sewing and fairly complex reconstruction that requires suturing. It is very difficult laparoscopically unless you’re a highly experienced laparoscopic surgeon that doesn’t really do anything else.”
In urology robotic surgery is compared to open surgery for most cases and certainly for the robotic prostatectomy and partial nephrectomy – surgeries for cancer of the prostate and kidney, he said.
The prostatectomy involves removing the prostate, a walnut-sized organ that sits in the very bottom of the pelvis.
“It’s a really very tight space,” Doak said.
If the prostatectomy is done with open surgery, it requires a 4- to 5-inch incision.
“Visibility down in that space when you’re doing an open prostatectomy is very poor,” he said. “A lot of the surgery has to be done by feel just because you can’t see down there because there’s too much stuff in the way.”
When a prostatectomy is done robotically, a camera is put in through a tiny incision at the belly button, with instruments inserted in similar incisions on either side.
“We can take that camera all the way deep down in the pelvis and see exactly what’s going on down there,” Doak said. “Visibility is excellent. We can see right where the nerves and the blood vessels are that are responsible for potency, for sexual function. We can see the urethra and the bladder. It allows for really good visualization of what’s going on.”
From the patient’s standpoint, he said, the recovery is shorter, the pain is less, the blood loss is less and there is a lower stricture rate.
“In terms of other things that patients care about like erectile dysfunction, urinary continence and that kind of thing, the robot has never been proven to be superior to open surgery,” Doak said.
But a robotic prostatectomy does offer the benefits of minimally invasive surgery.
“Our patients go home the next day instead of spending two or three nights in the hospital and they require very little pain medicine,” he said. “Many of my patients will go home and not require any narcotic pain medicine. They’ll just go home on Tylenol or ibuprofen. I don’t send them home without narcotic pain medicine, but a lot of times they will come back and tell me they didn’t need it at all, or they only took two pills.”
For the kidney cancer surgeries such as the partial nephrectomy, the open alternative is extremely morbid, requiring a large, painful incision, Doak said.
“Those patients used to stay in the hospital for a long time – three, four or five days,” he said. “They used to have to have an epidural for pain control for several days and would get tons of narcotics for pain. It was a really tough surgery to have.”
The benefit of the partial nephrectomy is that it allows the surgeon to remove the part of the kidney that has cancer and leave the rest of the kidney in place.
“A robotic partial nephrectomy allows us to do that with much less morbidity than we used to have to inflict on people,” Doak said. “They have great outcomes. They are able to retain their kidney and they are able to go home sometimes the next day or sometimes after two nights. They are up on their feet, usually, the same night as surgery. It is like night and day from having a big open surgery.”
