Minimally Invasive Laser Prostate Surgery in India

         Minimally Invasive Laser Prostate Surgery in India

Transurethral Resection of Prostate or T.U.R.-Prostate or T.U.R.P. is a treatment of choice if the enlarged prostate gland compresses on the urethra resulting in obstruction of urinary outflow. In the TURP, the glandular tissue is removed in small chips or pieces as opposed to Radical Prostatectomy where the prostate gland is removed in it's entirety. T.U.R.P. is an endoscopic procedure where the prostate gland can be visualized while it is being resected.

On the basis of the size of the prostate gland, different kind of prostatic procedures are decided. TURP is performed on the glands bigger than 30 grams and less than 80 grams. But if the prostate gland is bigger than 90 grams, open prostatectomy is performed. Prostatic surgery is not performed on the patients having bood clotting disorder or bladder disease (neurogenic bladder).

• Irregular or absent periods

• Hormone imbalance

• Smoking or alcohol use

• Endometriosis

• Fibroids

• History of infertility

Minimally Invasive Laser Prostate (TURP) 

Laser prostatectomy or Laser for prostatic surgery - Is recently developed minimally invasive treatment modalities for patients having BPH i.e benign prostatic hyperplasia or benign prostatic hypertrophy. The term Benign prostatic hyperplasia or benign prostatic hypertrophy means increase in size of the prostate gland in the men above 50 years of age. Laser Prostatectomy is used mainly to remove the prostate gland when there is no cancer in it but its size enlarges due to which it creates problem in the urinary tract. Laser prostatectomy is a short and easy procedure, usually after which the patient can return to their home on the day of operation itself.

Procedure for laser prostatic Surgery - Patients who has a history of BPH are recommended by their doctors to undergo laser prostatic surgery as because they cannot be treated by the medical therapy. Before the surgery the patients has to undergo several preoperative measurements like American Urologic Association symptom score, Uroflowmetry, Prostate-specific antigen and Transrectalultrasonography (TRUS). Laser prostatectomy uses beams of light to destroy prostate tissue. It is mainly done under the use of regional anesthesia. This laser beam helps in destroying any prostate tissue which blocks the opening of the urethra and bladder outlet. After the laser prostatic surgery, the rate of urine flow improves and reduces the symptoms of BPH. 

                             Advantages of Laser TURP

1. Safer & Faster

2. No blood loss

3. Shorter hospital stay & faster recovery

4. Highly beneficial for :-

o Patients on blood thinning agents like heparin, aspirin, clopidegrol etc

o Patients with kidney dysfunction

o Patients whose prostate gland size more than 60 gm

o Patients whose prostate gland size more than 60 gm

o Patients who are at poor risk for anesthesia

o Patients with cardiac complications or who have undergone joint replacement surgery

          Conventional vs Laser Prostatectomy / TURP

• For the conventional TURP, the resectoscope, a combined visual and surgical instrument is used, whereas the Laser procedure involves use of advanced laser energy to cut excess gland, thus there is no loss of blood & shorter hospitalization is required

• Blood thinning agents have to be stopped a week to 10 days before the procedure for conventional TURP, which puts the heart at risk, whereas the laser TURP is done with the blood thinning agents on board, which is highly beneficial for cardiac patients.

• Conventional TURP allows tissue removal at only 1gram/min, whereas laser can vaporize tissue as fast as 3-4 grams/ min.

• For prostates larger than 100gm, open surgery is required in case of conventional TURP, whereas lasers can effectively perform surgery in such large prostate cases

Best Treatment Options for Enlarged Prostate in India

Enlarged Prostate :

Laser Surgery for Enlarged Prostate

Green Light Laser PVP :Green Light Laser PVP (Photoselective Vaporization of the Prostate) is minimally invasive technique in the treatment of the enlarged prostate. It uses high-powered laser light combined with fiber optics to vaporize the overgrowth of prostate cells.

In this procedure the surgeon directs the laser at the prostate; the intense pulses of light emitted from the fiber are absorbed by the blood. Within moments, the temperature of the blood becomes so fine it causes the nearby cells to vaporize.

There is growing interest in this procedure by patients and as well as by the surgeons because of its simplicity and effectiveness. A temporary catheter is often inserted to allow urine to drain from the bladder. The procedure takes near about one hour.

The benefits of Laser Technique are really unmatched: 

• No Cut so Less Pain
• No Bleeding.
• There is no need of blood transfusion.
• Early return to normal activity and work.
• Patient is able to urinate better with a good stream.
• Complications occur less frequently and are mild if they do.
  

Surgical Treatment for Enlarged Prostate

1. Radical Prostatectomy :

In radical prostatectomy the surgeon removes all of the prostate gland and some of the tissue around it. It is done to treat prostate cancer. The techniques of radical prostatectomy surgery includes:

• Retropubic Technique: When the incision is made in the lower belly, it is called the Retropubic approach.
• Perineal Technique: When the incision is made in the perineum (between the anus and the scrotum) it is called the Perineal approach.

2. Laparoscopic Prostatectomy :

The prostate can be removed using keyhole (laparoscopic) surgery. The surgeon uses a thin tube with a video camera (laparoscope) inside the cuts which allows the surgeon to see inside the belly during the procedure. The video camera gives a magnified view of the prostate gland on a video screen. The surgeon cuts away the prostate gland from the surrounding tissues. The major difference with this surgery is that the surgeon makes several small cuts instead of one big cut.

3. Robotic Prostatectomy :

The world’s most advanced robotic prostatectomy surgery available is the da Vinci Surgical System. Robotic prostatectomy is becoming more popular as it is less painful and minimally invasive prostate cancer treatment. The da Vinci robotic prostatectomy enables surgeons to overcome many limitations of both open prostatectomy and laparoscopic prostatectomy.

The da Vinci surgical console consists of high-resolution cameras and micro-surgical instruments that enable the surgeon to perform robotic prostatectomy by controlling the device powered by robotic technology. During robotic prostate surgery the da Vinci robot provides the surgeon with improved visualization and precision compared with open or laparoscopic surgery. This allows the surgeons to perform fine computer-controlled movements and a more precise and minimally invasive robotic prostatectomy. It achieves the same or better prostate cancer treatment results than a surgeon’s own hands in open or laparoscopic surgery.

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Advantages of Laparoscopic and Robotic Surgery for Prostate Cancer:

1. Less Scaring: its minimally invasive. Instead of having a 5 or 6” incision to the skin and abdominal fascia, patients have a series of small “band-aid” incisions.
2. A Shorter Hospital Stay: With smaller incisions, the postoperative pain is significantly less, which means your length of hospitalization is shorter.
3. Less Drugs, Minimal Blood Loss:
   Patients’ need for postoperative pain medicine and narcotics is also greatly reduced after the laparoscopic/robotic approach compared to open surgery. During Robotic or laparoscopic prostatectomy, blood loss is very minimal and has a negligible risk of needing a transfusion.
4. Reduced risk of Erectile Function: Robotic prostatectomy’s ability to preserve the erectile nerves. During an open prostatectomy through an incision on the anterior abdominal wall, the nerves that provide erection are hidden behind the prostate. The approach taken using the surgical robot, enters the abdomen and the robotic arms are positioned posterior to the prostate with the nerves directly in front of the robotic/laparoscopic camera. In this way, the nerves maybe preserved, primarily because the anatomy can be seen more clearly compared to open 

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Treatment for Advanced Prostate Cancer 

1 ) Minimally Invasive Techniques : 

a) SPAD – super selective intra- prostatic androgen deprivation : In this procedure, a radiopaque dye is injected into the vein of the leg after which an X-ray of the venous network is carried out (venography). Then a medicine that shrinks the blood vessels is injected into the vein (sclerotherapy) resulting in reduction of prostate volume. This provides relief in cases of nocturia, improves bladder emptying and increases urine outflow. There are minimum sideeffects as compared to traditional surgery. 
b) Transurethral microwave thermotherapy (TUMT) : 

• It is a very effective treatment in case of BPH and provides relief from lower urinary tract symptoms after a single procedure. 
• It is a minimally invasive technique performed under local anesthesia. 
• A special microwave urinary catheter is inserted through the urethra into the enlarged prostate. The microwave antennae are then heated up to at least 111 degree Fahrenheit which destroys the surrounding tissues. 
• The procedure takes around 30 minutes to 1 hour after which there is slight swelling and irritation in the prostate. A Foley’s catheter is placed in the bladder to allow bladder emptying without increasing the prostatic irritation and is removed within 3-5 days. 
• There may be a few risks like pain after the procedure, urinary retention and infection but the incidence is very less. 
• The problem of urinary retention resolves within a week’s time, but some patients replace the Foley’s catheter with a temporary prostatic stent to allow volitional emptying of bladder. This improves their quality of life. 
c) Transurethral needle ablation (TUNA) : 

• In this procedure low energy frequency radio energy is delivered through two needles placed inside the prostate by passing through the urethra, creating a high temperature in a small zone, which destroys the excessive prostatic tissue without damaging the urethra. 
• The procedure is performed under local anesthesia on an outpatient basis. It is a single session treatment procedure with the number of needles varying with size of the prostate. 
• It is fairly safe and effective and has minimal side-effects. 

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2 ) Surgical Procedures : 

a) Trans urethral resection of prostate (TURP) : 

• It is the most popular method among patients and doctors for resolving prostate related problems and is considered after medical intervention fails. 
• It involves removing whole or a portion of the prostate gland through the urethra. 
• The procedure is performed under spinal or general anesthesia and involves visualizing the gland using a endoscope. 
• A Resectoscope (which contains an electrical loop to cut the bulging prostate tissue and seal the supplying blood vessels) is introduced inside the penis. 
• The surgery lasts for around 1 and half hours, and cut tissue is carried by fluid into the bladder from where it is washed out. 
• The patient can go home after 3-5 days. Patient is advised to drink lots of fluids and avoid any strenuous activity for a few days (maximum 6 weeks) till the scar heals. 
• He is cured of the symptoms occurring due to urinary pathway obstruction like urinary incontinence, dribbling, nocturia etc. 
• This procedure has very few side effects and a faster recovery period. But sometimes it can cause backward ejaculation of semen (into bladder instead of urethra) during intercourse. This can be managed by certain drugs that keep the mouth of the bladder narrow to reduce backward flow of semen into it. 
b) Radical Prostatectomy : 

• It is the traditional open surgery method used when TURP cannot be performed due to reasons like highly enlarged prostate or bladder injury etc. 
• It is mainly indicated in prostate cancer but can also be done in cases of BPH. 
• The surgery is performed under general anesthesia and an incision is made in the lower abdomen just above the pubic bone (Retropubic approach). At times the incision can be made between the scrotum and the anus depending on the enlargement of the gland or spread of the tumor (Perineal approach). The incision of perineal approach is smaller and has lesser blood loss as compared to retropubic approach and hence has a faster recovery period. 
• On reaching the prostate gland, the gland and extra tissue is scooped out and in case of any injury to surrounding organ like the bladder; a tissue repair is carried out. The urethra is reattached to the bladder and a catheter is left in the bladder to drain out urine. 
• In case prostate cancer is suspected, then surrounding lymph nodes are also removed and sent for biopsy. 
• The patient stays in the hospital for a week and is discharged with the urine catheter in place that has to be kept for 1-3 weeks’ time. 
c) Laser Prostatectomy : is the latest trend in BPH and prostate cancer surgeries because they have lesser blood loss and quicker recovery period. But long term effects of this surgery are yet to be determined. 
There are four Types of Laser Surgeries: 
1. Green Light PVP Laser : This procedure uses green light to vaporize the prostate and useful for majority of patients with enlarged prostate. A tube with light and lens called the cystoscope is inserted into the penis. The laser beam is introduced through the cystoscope and directed towards the prostate. It creates high energy which vaporizes the excess tissue and relieves the urethral blockage. The procedure is done in a short time and the patient can go home the same day and resume daily non strenuous activities within a couple of days.
2. Holmium Laser : This is the most commonly used technique and is performed under general anaesthesia. The laser of 2140nm wavelength and 0.4mm penetration is introduced through the cystoscope that is inserted into the penis at the start of the procedure. The laser cuts and vaporises the enlarged prostate tissue and relieves urinary blockage. Some tissue pieces are directed to the bladder from where they are flushed out. The procedure is done in a short time and the patient can go home the same day or the next day and resume daily non strenuous activities within a couple of days. The procedure is relatively bloodless. 
3. VLAP : This procedure has many disadvantages and has become virtually obsolete with the coming of Holmium Laser. The technique uses neodymium:yttrium-aluminum-garnet (Nd:YAG) laser which has a wavelength of 1064nm. The laser beam is directed towards the prostate gland via the cystscope. The beam generates a lot of heat which coagulates the gland tissue. The surgery is performed under regional or general anaesthesia. The technique was not popular among patients as the coagulated portion caused irritation. Also the urine catheter had to be kept for long. Soon this was replaced by Holmium Laser. 
4. ILC : Interstitial Laser coagulation therapy was used to coagulate tumours which could not be cut and removed especially in the brain, neck, liver, pancreas etc. in this procedure the laser probe is in direct contact with the prostatic tissue and generates temperature of 60 degrees Celsius which destroys the cell protein. The destroyed cells are absorbed in due course of time and a shrunken prostate gland remains. The urethra is not affected. The procedure is performed under general or regional anaesthesia. The rigid laser probe is inserted through the cystoscope and pushed till it enters the prostate after which it is activated to produce the heat. The effect is localised to the prostate tissue only. 

d) Robotic Prostatectomy : This procedure is carried out using the computer and is an advanced form of minimally invasive surgery. In this technique, small incisions are made in the lower part of the abdomen and the entire surgery is carried out using Tele-manipulator. The surgeon performs actions, which moves the Tele-manipulator which in turn is connected to the robot’s arms which replicate the surgeons hand movements and perform the surgery. The surgery is controlled remotely but involves great precision because of which it is soon becoming very popular. The procedure has resulted in favourable outcome as there is less blood loss, faster recovery and shorter hospital stay. 
Surgeons also perform laparoscopic robot assisted surgeries using the Da Vinci system which uses miniature surgical tools to carry out the surgery through the keyhole incisions. This method is gradually gaining popularity in treatment of prostatic cancers as there is great precision involved while removing the prostate gland without affecting the other tissues. 

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Advantages of Robotic prostatectomy

• Minimal Bleeding Faster return to normal daily activities .

• Reduced hospital stay Significantly less pain and scarring

• Lower blood transfusion rates

• Improved preservation of physical appearance.

• Three (3) D vision enables surgeon to perform Prostate excision with Cancer.

• Lower blood transfusion rates

• Control without risk of Post Surgery Continence (control over urinary and fecal discharge) and causing Impotency

Scope of Robotic assisted Laparoscopic surgery in Urology

• Prostate Cancer- Robotic Radical Prostatectomy

• Pelvi-Ureteric Junction (PUJ) Obstruction- Robotic Pyeloplasty

• Kidney Tumors- Robotic Partial Nephrectomy

• Bladder Cancer- Radical Cystectomy

• Ureteric Reimplantation

• Pelvic Tumor Excision

Robotic surgery involves use of the da Vinci robotic surgical unit in performing complex surgical procedures such as prostatectomy (removal of the prostate gland for cancer). Originally developed for space and military uses, this advanced technology allows the operating surgeon to sit behind a console and control the robot that is next to the patient to perform surgery.

This technology allows the surgeon to operate with very small and precise instruments under a 3 dimensional (3-D) vision, which is magnified up to 10 times. This is achieved by inserting the camera and the instruments into the patient’s body through small cuts (incisions) ranging from 5 – 12 mm in size.

Da Vinci Master Slave Robotic System

The surgical application of robotic systems is one of the most exciting and significant technological developments of this century; its future implications are incalculable.Huge strides have been made in the field of closed operations in the past 10 years and the use of robotic systems has emerged as the principle solution to technical limitations

The use of robotic surgical systems has numerous advantages. Whereas modern laparoscopic systems give only

 a two-dimensional vision, robotic systems give the surgeon a three-dimensional field of vision and depth, provide arms that, unlike the human hand, never tire and permit an unprecedented continuityin operations. Since robotic systemsexceed even the human hand’s freedom and facility of movement, far greater delicacy and dexterity is achieved. Modern robotic systems fall into three categories; active, semi-active and master-slave.But the most commonly used are master-slave systems distinguished by the surgeon’s absolute control of the robot via a remote control console.

The Da Vinci is a sophisticated master-slave robot that incorporates 3-D high definition visualization, scaling of movement, and wristed instrumentation. The operations with the Da Vinci System are performed with no direct mechanical connection between the surgeon and the patient. The surgeon is working a few feet away from the operating table, while seated at a computer console with a three-dimensional view of the operating field.

Robotic Prostatectomy, also known as Robotic surgery for prostate cancer or da Vinci Prostatectomy is a minimally invasive surgery that is now the preferred approach for removal of the prostate in those diagnosed with organ-confined prostate cancer. The da Vinci Prostatectomy may be the most effective, least invasive prostate surgery performed today. Though any diagnosis of cancer can be traumatic, the good news is that if your doctor recommends prostate surgery, the cancer was probably caught early. And, with da Vinci Prostatectomy, the likelihood of a complete recovery from prostate cancer without long-term side effects is, for most patients, better than it has ever been.

The operation is performed using the daVinci Surgical system and 3-D endoscopic and wristed instruments inserted through 5-6 small incisions across the mid-abdomen

Treatment for Advanced Prostrate Cancer in India - Best Cancer Hospital India

Prostate cancer refers to cancer that occurs in a man’s prostate gland. Prostate is essentially a small, walnut-shaped gland which produces the seminal fluid that transports the sperm.

One of the most common types of cancer in men, Prostate cancer generally grows and spreads slowly and often remains confined to the prostate gland. In such cases, it may not cause much danger. However, there are certain other types of Prostate cancer which are very aggressive and can spread rather quickly.Early detection of Prostate cancer offers better chances for successful treatment.

Prostate cancer is mainly caused when some of the cells in the prostate become abnormal. Due to the mutations in the DNA of these abnormal cells, they tend to develop and divide very rapidly in comparison to the normal cells. While the abnormal cells multiply, the normal cells would begin to die. The faster accumulation of abnormal cells could result in a tumor that can spread to the nearby tissues, thus damaging them too. Certain abnormal cells can even metastasize i.e. break off and spread to various other parts of the body.

Symptoms:

• Trouble in urinating
• Reduced stream of urine
• Blood in the urine or semen
• Swelling or inflammation in the legs
• Discomfort in the pelvic region
• Bone pain

Who are at risk ?

• Old age: Prostate cancer is common in men who are above 65 years.
• Black men are at a greater risk of prostate cancer when compared to men of other races. In black men, prostate cancer tends to be more advanced.
• Family history of prostate cancer
• Obesity

Complications of prostate cancer

Prostate cancer can spread to the various organs in the body. It can travel through your bloodstream or lymphatic system and spread to your bones. Moreover, it can block the ureters that transport urine from the kidneys to the bladder, thus resulting in kidney problems. If the prostate cancer is in an advanced stage, it can cause extreme fatigue, weakness and weight loss, pain and broken bones.

Incontinence: Prostate cancer and its treatment can result in urinary incontinence. Treatment for urinary incontinence may include medications, catheters and surgery.

Erectile dysfunction: Prostate cancer or its treatment including surgery, radiation or hormone treatments could lead to erectile dysfunction. However, certain medications and vacuum devices that help in achieving erection and surgery are available for the treatment of erectile dysfunction.

If you are suffering from either of these symptoms, consult your family doctor or a general practitioner. If your physician suspects that you are having a problem with your prostate, you would be referred to an urologist. In case you are diagnosed with prostate cancer, you would be referred to an oncologist or a radiation oncologist.

Diagnosis of Prostate Cancer

Digital Rectal Examination (DRE)

The rectum is located close to the prostate gland. The doctor will examine if there are any abnormalities in your rectum. If your prostate gland is cancerous, it may feel very hard and knobbly. In an individual who is suffering from Benign Prostatic Hyperplasia (BPH), the rectum is generally enlarged, firm and smooth. However, very often, the prostate may feel quite normal, even though cancer cells are present.

Prostate-specific antigen (PSA) tests

A sample of your blood is taken to check for prostate-specific antigen (PSA). Prostate-specific antigen is a protein produced by the prostate. A small amount of PSA is generally found in blood. Men who have Prostate cancer tend to have more amount of PSA in their blood. However, the PSA test cannot be always relied upon and sometimes, men who have prostate cancer will have normal PSA. The increase in the PSA level could be also due to several other factors such as urine infections, recent prostate biopsies, having a urinary catheter, prostate or bladder surgery or a prostatic massage. PSA levels higher than normal could be mostly due to prostate cancer and a biopsy would often be recommended. Men who have PSA levels of 5 ng/ml or above are mostly referred for further tests.

Trans-rectal Ultrasound Scan (TRUS)

Ultrasound scans make use of sound waves to create an image of a certain region or organ inside the body. A small probe is inserted into the rectum and an image of the prostate gets displayed on a screen. The TRUS scan is mainly used to assess the size and density of the prostate.

Biopsy

If the initial tests reveal that there is a possibility of cancer, you may be recommended a biopsy. In this process, numerous samples of tissue (generally around 12) are extracted from the prostate for careful inspection under a microscope. The biopsy is usually performed at the same time as the ultrasound scan.

Diagnosis of advanced prostate cancer

If the biopsy shows the presence of prostate cancer, several tests may be required to determine whether the disease has spread to other organs/regions in the body. These tests include.

• Isotope bone scan
• X-rays
• MRI scan
• CT scan

Treatment options for early prostate cancer

The major treatment options for early prostate cancer include:

• Watchful waiting
• Surgery or removal of the prostate gland
• External beam radiotherapy
• Brachytherapy

If the prostate cancer is likely to develop and spread slowly and if you are elderly and not good enough for treatment such as surgery or radiotherapy, you may be recommended watchful waiting. In case the symptoms start developing, you may required to undergo treatment, such as hormonal therapy, For older men, hormonal therapy may be recommended after radiotherapy.

Young people who have low-grade early prostate cancer may be recommended active surveillance. If the cancer starts to progress, they will be asked to undergo surgery or radiotherapy.

People who have moderate- to high-grade cancer are likely to be recommended Radical Prostatectomy or surgery to completely remove the prostate gland or radiotherapy of the prostate. These treatments help to eliminate all the cancer cells and thus cure the cancer. The radiotherapy can be given to the patient using an external machine or even directly into the prostate gland. This process is known as Brachytherapy.

Although for some people these treatments will cure the cancer, in certain others some of the cancer cells may still be left behind after the treatment. In some others, the treatment may help to do away with all the cancer cells for a certain period of time, but the cancer may regenerate in the future. Cryotherapy or high-intensity focused ultrasound (HIFU) treatment can also be offered to people who are in the early stage of prostate cancer.

Treatment options for men with locally-advanced prostate cancer

There are numerous factors which need to be taken into account prior to deciding the best treatment options. This includes:

• Your physical health
• The stage and grade of the prostate cancer
• The PSA level
• The potential risks or side effects of treatment
• Whether you had treatment before.

The treatment options for locally-advanced prostate cancer mainly include Radiotherapy, Hormonal therapy, Watchful waiting and Surgery. Sometimes, different combination of treatments will be provided to the patient.

It is extremely important for you to be fully aware of the benefits, disadvantages and side effects of each of these treatments before you decide on the treatment. Your doctor or specialist nurse will provide you detailed information on the various treatments.

Treatment for Advanced Prostrate Cancer

The treatment options for advanced prostate cancer mainly include Hormonal therapy, Surgery, Chemotherapy, Radiotherapy and controlling symptoms. Surgery to remove the prostate gland is not recommended for men with advanced prostate cancer. However, a transurethral resection of the prostate (TURP) can help to relieve problems associated with passing urine.

Unfortunately, if prostate cancer has spread beyond the prostate gland and has severely affected other parts of the body, it cannot be cured. However, you can undergo treatment to control the cancer for several years and relieve the symptoms if any. This will help to improve the quality of your life.

Minimally Invasive Robotic Prostate Surgery in India - Less pain and Reduced blood loss

Robotic Prostate Surgery Service - where a minimally invasive robot assisted radical prostatectomy technique eradicates prostate cancer with minimal post surgery complications

The mission of “Minimally Invasive Robotic Prostate Surgery Program” is to leverage latest technology to and treat prostate disease through small incision and great precision resulting in:

·  Shorter hospital stay, Faster recovery and return to normal activities

· Less pain and scarring , Reduced blood loss and need for blood transfusion

·  Reduction in the use of pain medicines, Decreased postoperative pain

Usually in conventional approach surgeons make decisions using tactile and visual cues to identify a phenomenon, which is actually microscopic which is likely to damage nerves or to leave some cancer behind.  Sometimes it is difficult for surgeons to find a precise plane between the cancer and urinary sphincter or the nerves and err on the side of cancer safety leading to incontinence or Impotence

Highly trained Indian surgeons who have worked for decades at some of the global centres of excellence now use Advanced Robotic technique gives surgeon a sophisticated master slave robot that seamlessly translates the surgeon's movements at the computer console into precise, real-time movements of the surgical instruments inside the patient. This ensures that the Prostate is removed excellent outcomes and minimal chances of cancer left behind after the surgery.

If you're young and in good health, the short-term risks of this surgery are low. The hospital stay is usually 2 to 3 days, with the catheter left in place for 2 to 3 weeks. You're usually able to go back to work in about 1 month. You shouldn't have severe pain with this surgery. Most men regain bladder control a few weeks to several months after the surgery.

The main advantage of surgery is that it offers the most certain treatment. That is, if all of the cancer is removed during surgery, you are probably cured. Also, the surgery provides your doctor with accurate information about how advanced your cancer is, since the nearby lymph nodes are taken out along with the tumor.

 Surgery does have risks. The main risks of radical prostatectomy are incontinence (loss of bladder control) and impotence (loss of the ability to get or keep an erection long enough to have sex). Most bladder and impotence problems improve with time.

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