Robotic Simple Prostatectomy: Not So Simple!

Robotic Prostatectomy So if you are new to Dr.Bevan-Thomas.com or you are just getting started here, one common theme that you will notice is that prostate size really does matter. It may not be something to brag about when you go to the barber shop, but it’s important nonetheless. A larger prostate does not always mean that a man will get BPH symptoms or have a higher IPSS score; however, they are at higher risk of developing BPH symptoms in the future.

If you are a man with BPH symptoms or an enlarged prostate, it is imperative that Dr. B-T evaluate the size of the prostate. The minimally invasive options (Urolift and Rezum) are great for men with smaller- to medium-sized prostates, but once the prostate gets larger than 100 grams, these are no longer options that get results.

Remember the IPSS questionnaire. These 100 gram-plus sized prostates are twice the size of the average prostate and usually require a different approach. Dr. Bevan-Thomas specializes in robotic surgery, so he has you covered. Dr. B-T has removed prostates up to 6 times the average size!

THE SIMPLE PROSTATECTOMY IS FOR BPH/ENLARGED PROSTATE - NOT CANCER!

The robotic simple/partial prostatectomy is a modern take on the older version of the simple prostatectomy. It was termed the simple or open prostatectomy because the urologist would make a large incision in the lower abdomen and core out the middle of the prostate with finger dissection. It was not a radical prostatectomy because the entire prostate was not removed. The patient did not have cancer, so by leaving the outer core of the prostate, there was less risk for erectile dysfunction and incontinence.

The goal of the simple prostatectomy is to remove the inner part of the prostate, like removing an orange while leaving the orange peel in place. This open surgery is still performed throughout the United States for men with larger prostates, but there is a higher risk of blood loss, patients are routinely in the hospital for several days on continuous bladder irrigation, and patients have more pain because of the large incision made to get to the prostate.

Fortunately for men in the Dallas-Fort Worth metroplex, Dr. B-T performs the robotic simple/partial prostatectomy.

SO THE DAVINCI ROBOT TAKES MY ORANGE OUT?

Dr. Bevan-Thomas uses the daVinci robot for most of his surgeries and for all of his simple/partial prostatectomy surgeries. Despite any preconceived notions you may have of robots, the daVinci robot does not physically do the surgery; it merely acts as a way for the surgeon to control the laparoscopic instruments. Fortunately, in 2020 A.D., most people have heard of laparoscopy. Laparoscopy is simply using a scope through small keyhole incisions to look inside the abdomen. Unfortunately, the instruments we use for this are like chopsticks.

Sure, surgery can be done with these instruments, but they are more difficult to maneuver. The robotic console (daVinci) has its own version of these chopsticks, and Dr. Bevan-Thomas is able to control these instruments more precisely. Simply put, it’s like having little hands at the end of the chopsticks making surgeries easier and more precise for the surgeon.

The surgeon (Dr. B-T) sits at a console and manipulates the instruments like a joystick on the XBox. The daVinci is like the XBox, not like a soda machine with buttons labeled Prostate, Kidney, and Bladder. Dr. B-T’s hands do all the work; the robot’s are just tools that make his work easier and more precise.

OK, SO WHY USE A ROBOT AND NOT ONE OF THE OTHER PROCEDURES?

All of the treatments for BPH are good options, but when prostates get too large, there is just too much prostate to squeeze open (Urolift) or shrink with steam (Rezum). The Greenlight laser is not a bad option, but if the prostate gets too big, i.e., greater than 100 to 120 grams, it could take several hours to get the tissue needed to get results. There is also a higher risk of bleeding and inferior results. The robot enables Dr. Bevan-Thomas to literally core out the inner part of the prostate (like an orange) and leave the orange peel behind.

Although a more challenging procedure, Dr. Bevan-Thomas offers robotic surgery to men with larger prostates because of its excellent results. Most patients feel like they are “peeing like they are 15 again,” or as Dr. B-T describes it, “like a racehorse.” The results for these patients are routinely much better because more tissue is removed. The obstruction is literally gone, and men are able to urinate freely again without the pesky large prostate getting in the way.

There are many advantages of the robotic simple/partial prostatectomy, including:

Leaving the sphincter alone, thus minimizing risk of incontinence.
Removing more tissue than the other procedures.
Obtaining tissue for pathology to evaluate for cancer.
Routinely a two-hour procedure, and patients go home the next day.
Catheter removed within one week after procedure.
Lower risk for blood loss.
Minimal pain — done through keyhole incisions in the abdomen.
Patients see immediate improvement after the catheter has been removed.

SO DO THE KEYHOLE INCISIONS HEAL BY THEMSELVES?

Similar to any laparoscopic surgery, the keyhole incisions heal themselves. Dr. B-T recommends not lifting anything heavy for the first four to six weeks after the procedure to minimize the risk of developing a hernia.

WHY SHOULD I USE DR. BEVAN-THOMAS FOR THIS PROCEDURE?

Robotic surgery is a skillset and Dr. Bevan-Thomas has been performing robotic surgery since leaving UT Houston and MD Anderson Cancer Center in 2002. He has been perfecting his robotic skills for the last 18 years, and most importantly, he will help you make the decision that is best for your condition and size of your prostate.

Although most men will not require a robotic simple/partial prostatectomy, it is in Dr. B-T’s arsenal, so whether your prostate is the size of a strawberry or the size of a grapefruit, he is willing and able to tackle your prostate issues.