FAQs
- Why is a robotic prostatectomy better than open or laparoscopic?
- Are there any disadvantages to robotic prostatectomy?
- What can I expect before and after robotic prostatectomy?
- What about impotence and incontinence?
- Am I a Candidate to Participate In a Clinical Research Study?
- What is a robotic pyeloplasty?
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Our Robotic Surgery RESEARCH
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Introduction to Laparoscopy Robotic Surgery
To understand what robotic surgery is, one must learn what laparoscopic surgery is. Laparoscopy literally means "scope in abdomen", and is a surgical approach that has transformed minimally invasive abdominal surgery in general. Laparoscopy is a style of surgery that is designed to perform an abdominal or pelvic surgery without making large incisions. It accomplishes this through the placement of "ports" into the abdomen through very small incisions. A camera is used through one of these ports to allow visualization, and a wide assortment of instruments is then used through other ports to perform the surgery. The surgeon's hands are outside the body, and the operation is performed on a video monitor. A laparoscopic surgery accomplishes the exact same mission as its more invasive, open counterpart. The advantage of laparoscopy is usually better visualization, less blood loss, and strikingly improved recovery times. Within Urology, and especially for Drs. Engel and Frazier within Urologic Surgeons of Washington, laparoscopy has become the standard approach for nearly all kidney surgery, including complex operations such as partial nephrectomy.
The disadvantage of standard laparoscopy is not only that it is difficult to learn and to fully master, but also that it provides only 2-D visualization (which makes depth perception difficult) and that its instruments are very limited with regard to what movements they can perform. One way to overcome this is to perform hand-assisted laparoscopy, which we regularly perform. However, the best way to overcome this would be to design a laparoscopic system that provides 3-D visualization, and uses instruments that mimic the human hand in every way. These two major breakthroughs are what the Da Vinci robotic surgical system provides. Now, after significant practice and learning, the surgeon and patient can enjoy the benefits of all the advantages of laparoscopy such as access to tight places, better visualization, less blood loss, and faster recovery, without the visual and manual limitations previously seen. For the first time, the goal in a laparoscopic operation, such as radical prostatectomy, is to perform the operation better than could ever be done through a large incision, with the goal being not only to improve recovery time for the patient, but also to improve outcomes.
Combined, Drs. Engel and Frazier have performed nearly one thousand robotic surgeries. We use the robotic surgery system to its full advantage, and since founding the program at George Washington we have seen major advantages to our patients. We review our data regularly, and have published several papers on prostate cancer surgery outcomes. Our complication rate is one of the lowest in the country, as is our positive margin rate. Through Dr. Engel's research on erectile dysfunction after prostatectomy, he has shown a significant improvement over the open procedure regarding penile shrinkage after surgery (there is none in Dr. Engel's series), and at least equivalent sexual outcomes when compared to the open approach. As has been known for some time, recovery time has also been drastically improved. Now, Dr. Engel and Frazier have begun to apply robotic surgery to several operations other than radical prostatectomy within the field of Urology, including kidney reconstruction such as pyeloplasty, and distal ureteral surgery such as repair of ureteral injury, strictures and ureteral implantation. You are invited to view our videos of these operations elsewhere on this site.