Robotic Cancer

Domenico Savatta, M.D.

Chief Of Minimally Invasive and Robotic Adult Urologic Surgery

Newark Beth Israel Medical Center

1st robotic urologic training course instructor on the daVinci S robot in the northeast

 

RESULTS FOR Da VINCI PROSTATECTOMY

I periodically update my results (updated 6/20/2007) in terms of cancer control (positive margins), urinary control (how many pads do my patients use to control their urinary leakage), and sexual function. 

In my practice I routinely perform robotic prostatectomy on patients that may lead to poorer outcomes including aggressive cancers, very large prostates, prior pelvic and prostate surgery, and many others.  This data should not be taken by anyone as their expected results and they should seek personal advice from a licensed urologist.

Cancer control- The best long term marker of cancer control is the mortality due to prostate cancer.  This takes decades to follow.  PSA recurrence after surgery is a good marker for cancer recuurence, but often takes years.  The amount of positive margins (meaning cancer cells may have been left behind) is a good short term estimate of cancer control.  Although not all patients with positive margins recur and patients with negative margins can have cancer recurrence, this is our best test. 

I have tabulated my positive margin rate for patients who were found to have cancer contained to their prostate.  I have also shown the total number of cancer recurrences as measured by a PSA > 0.2

  Positive margins Cancer recurrences
Patient 1-50     9/42 (21%)            2 (5%)
Patient 51-295   22/226 (9.7 %)            2 (1%)

Recently the positive margins have been 5% for organ confined disease.

Blood loss- None of my 295 patients have received any blood during surgery or the immediate postoperative period.  I had 1 gentleman who received blood thinners for a pre-existing condition who needed a blood transfusion several days after surgery.

Hospital Stays- Most patients go home the next day.  Over the last 260 patients, over 90% have gone the next day and only 6 have stayed longer than 48 hours.

Urinary control-  Most men have some leakage after radical prostate surgery.  Recently I have used new techniques to help minimize the chance of leakage after surgery. 

Starting at dvP number 245 I added the "Rocco" stitch, which adds support behind the urinary tract.  This helped some patients have rapid retrurn of urinary control.  After 275 operations, I added several other sutures and modified the Rocco stitch and have seen even better urinary control for some patients.

The following chart depicts how many men pads per day patients number 50 to 260 had to wear .

Number of patients
0 pad
1 pad
2 pads
> 2 pads
1 month ( 174 patients)
32%
30 %
20 %
18 %
3 months  (107 pts)
65%
21%
9%
4%
6 months (57 pts)
86 %
12%
2%
0%
12 months (14 pts)
93 %
7 %
Not enough time

After 50 patients, I started to see better urinary control.  I believe the results for the first 50 were similar to my open results. 

As I have performed more dvPs, the control has been considerably improved to my open results.  The majority of this is too technical improvements in the operation, but I also have been stressing that patient's perform preoperative Kegel exercises more recently.  I believe the addition of the reconstruction sutures will prove to help significantly.

Return of erections-  Most men have lost their erections after radical prostate surgery.  I think originally the results were similar to open surgery, but have I had more experience and I have adopted some newer techniques to spare nerves I have had better results.  The data below only includes men that have normal erections to start and had both nerve bundles spared during surgery.  Most urologists judge the ability to have erections with the addition of medicines such as viagra, levitra, and cialis.

 
# pts
Capable of Intercourse +/- PDE5 inhibitors
1 month
3 months
Patients 51-265
73
25/62 (40%)
23/37 (62%)

 

Catheter removal- Removing the catheter sooner helps patients return to work sooner.  I often was able to remove the catheter after 1 week at the beginning of my robotic experience.  After 200 cases I have been able to remove the catheter more reliably.  I have not needed to leave a catheter in longer than 9 days on any patient after 200 and have usually removed the catheter 4-5 days after surgery.  I also stopped performing x-rays routinely after 200 operations.

 

Contact Dr. Savatta

Dr. Savatta has performed over 300 daVinci Robotic Prostatectomies and almost 400 Robotic operations

Dr. Savatta's Hospitals for Robotic Surgery