Robot-Assisted Laparoscopic Prostatectomy

For qualified candidates, robotically assisted prostate surgery offers numerous potential benefits over the traditional open prostatectomy, including shorter hospital stay, less pain, less risk of infection, less blood loss and transfusions, less scarring, faster recovery, and quicker return to normal activities.

The da Vinci® Surgical System is powered by state-of-the-art robotic technology. The System allows your surgeon's hand movements to be scaled, filtered and translated into precise movements of micro-instruments within the operative site. The magnified, three-dimensional view the surgeon experiences enables him to perform precise surgery in complex procedures through small surgical incisions.

Dr. Caruso is one of the few fellowship trained urologists in the region in the arena of laparoscopy and robotics. His robotic experience spans several years and began at NYU Medical Center in 2001, He then helped develop a robotic prostate surgery program at St. Luke’s Baptist Hospital in San Antonio, Texas with Dr. Naveen Kella. He came back to his roots in northern New Jersey and became Director of Laparoscopic and Robotic-Assisted Urologic Surgery at Essex-Hudson Urology. He has instructed other surgeons in performing the robotic-assisted prostatectomy and has lectured on this topic at a national level.

Dr. Lombardo also has a significant background and training in robotic-assisted prostate surgery from both Hackensack University Hospital and The University Hospital in Newark. He is very skillfull and we have been extremely fortunate to have the addition of his experience in this new and innovative realm of surgery. Dr. Hsieh has been instrumental in helping to develop our robotic program and has proven masterful in the art of assisting at the patient’s bedside. We also perform Robotic-Assisted Pyeloplasty for a condition called uretero-pelvic junction (UPJ) obstruction where the drainage of urine from the kidney is blocked.

Learn more about robotic prostate surgery by reviewing the frequently asked questions, or checking this link to www.davinciprostatectomy.com. You can also see a detailed video of an actual surgery performed by Dr. Caruso and Dr. Hsieh by clicking below. (This video is graphic and includes scenes of real surgery. It's not for everyone, but it's an overview of the latest in operative technology and the benefits of robotic-assisted surgery.)

Laparoscopic Surgery

Pioneering procedures such as laparoscopic and minimally invasive applications in urology have dramatically improved the treatment of various disorders, tumors and malformations of the kidney, as well as other urologic organs. Until recently, patients with kidney cancer or obstruction would often undergo surgery with a large incision and significant post-operative recovery.

Using a miniature camera and tiny surgical instruments we can now remove a diseased or cancerous kidney without performing major surgery.

Performed through narrow tubes rather than large incisions, the laparoscopic approach benefits a patient by allowing a shorter hospital stay, less pain, a better cosmetic result and a quicker recovery compared to major surgery. Specifically this means that a kidney can be removed with three small holes, all less than a half an inch in length, and the patients can go home in one to two days and are back to work in about 10 days. For kidney-cancer patients this is all accomplished with equivalent cancer control as compared to open surgery.

The first laparoscopic nephrectomy for cancer was performed in 1991. In the past few years, dramatic improvements in instrumentation and surgical training have made the laparoscopic approach a standard of care for virtually all renal surgeries. Both Dr. Caruso and Dr. Lombardo have extensive training and experience in the following minimally invasive laparoscopic treatment approaches.

Laparoscopic Radical Nephrectomy

Patients with kidney cancer can be treated by either laparoscopic radical or partial nephrectomy. The word radical in this case means that the entire kidney, its surrounding fat, part of the ureter, and possibly the adjacent adrenal gland are removed. Currently, laparoscopic radical nephrectomy can be used for tumors up to about 10 cm.

This procedure is performed through three to five small holes in the abdomen and takes between two to three hours. Inside the body, the blood vessels leading to the kidney are identified, clipped and divided. The surrounding structures are dissected away and the kidney is placed inside a "sack." The neck of the sack is pulled out one of the incisions and the kidney is divided into small portions to remove it. This enables the entire surgery to be performed without any incisions larger than 2 cm. Since the sack is resistant to cells and fluid, it is safe to remove a cancer in this manner. Once the kidney is removed, all the instruments, drapes, gowns, and gloves are changed to further protect the patient from cancer spread.

Success rates for this procedure are equivalent to open radical nephrectomy and, the significant benefits to the patient are shorter hospital stays (one to two days), less pain, less blood loss, less complications such as hernia or bowel adhesions, and earlier return to work (10-14 days).

Dr. Caruso has co-authored a online book chapter on this technique of Transperitoneal Laparoscopic Radical Nephrectomy. You can see this article at Emedicine.com by clicking here.

Laparoscopic Partial Nephrectomy

In a partial nephrectomy, a tumor or portion of the kidney is removed rather than the entire organ. This procedure can be performed laparoscopically for the appropriate patient, usually when the tumor is less than 4 cm.

The procedure involves three to five small incisions in the abdomen and takes between two to three hours. The kidney is dissected away from surrounding structures, identifying the renal artery and vein. These vessels are clamped and the diseased portion of the kidney is removed. The remaining kidney is then sewn closed with suture.

Post-operative pain and recovery are similar to that for the laparoscopic radical nephrectomy.

Laparoscopic Renal Cryotherapy and Radiofrequency Ablation

One exciting new treatment for kidney cancer is ablative therapy. This involves eliminating the cancer cells in the kidney without actually surgically removing the tumor. This may represent the near future of all cancer surgery; as technology improves and the tools available to surgeons.

Two current technologies being used for kidney cancer ablation are cryotherapy (freezing) and radiofrequency (heating). We are currently performing cryotherapy for small renal tumors (2 to 3 cm) in patients who need to save as much functional kidney as possible. Cryotherapy is performed through a laparoscopic approach, with ultrasound imaging aiding in positioning the cryoprobes into the tumor. Once in place, the probes are supercooled to kill the targeted tissue. Recovery is similar to the above laparoscopic renal procedures.

Even less invasive than this is radiofrequency ablation of a small kidney cancer. This procedure is performed in the radiology suite using a CT scanner to direct a needle into the renal tumor. Once in the correct location, the needle heats the cancer tissue until it dries up and dies. The potential benefit is a cancer treatment with an even faster recovery than the laparoscopic approach. This is reserved for small posteriorly located tumors especially for elderly patients as local recurrence rates may be slightly higher than with cryoablation.

Prostate Cryoablation

Cryoablation, also known as cryosurgery or cryotherapy, is a medicare-approved, minimally invasive procedure that kills prostate cancer by freezing the cancerous cells.

With Cryoablation, the physician inserts 6-8 slender probes into the prostate gland. Contained within each probe is argon gas cold enough to freeze the entire prostate. A warming catheter protects the urethra from the very cold temperatures.

Recent advances have made cryosurgery extremely safe and highly effective. Ultrasound images allow your doctor to guide the probes to the best possible positions for killing the cancer. Temperature sensors carefully monitor the process and precisely determine when target temperatures have been reached.

The benefits of the procedure include a choice of general or local anesthesia, a fast recovery and lower risk of potential side effects, such as incontinence. In fact, incontinence affects less than five percent of cryosurgery patients--less than with other procedures. On the other hand, this procedure carries a high risk of impotence.

Laser Vaporization for BPH

It's not cancerous, but an enlarged prostate (BPH) can be uncomfortable for the more than 50 million men who have it. Now a new laser procedure can help treat some men who suffer from this common problem.

The normal prostate is about the size of a walnut, but it can grow very large, even as big as a baseball.

As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination.

While there is no cure for BPH, there are numerous standard treatment options including drug therapy, microwave procedures and surgical options.

The laser prostatectomy is the first significant advance in the treatment of BPH in fifty years, this new laser technique greatly decreases the risk of serious complications from the surgery, and allows patients to be immediately free of symptoms without a catheter and quickly return to work.

The procedure involves feeding a laser tip through the urethra into the prostate using a thin tube. The laser energy, which is nothing more than high intense light source, vaporizes the excess tissue. The procedure spares the patient from painful surgery that can potentially cause incontinence and excessive bleeding. Since there's no swelling, many patients do not even go home with a catheter.

Since the prostate continually grows over a man's lifetime, the tissue can grow back. As many as 90% of men will have an enlarged prostate by the time they reach their seventies, but not all of them will need treatment.

Pictures of renal tumor Cryoablation: