Da Vinci

The Da Vinci surgical system is a new cutting-edge technology in surgery using highly developed modern medical techniques to treat prostate cancer. In a Da Vinci prostatectomy the entire prostate is removed, and if necessary, the surrounding tissue as well. The chances of impotency and incontinence are brought down to a minimum with this treatment.

How does the Da Vinci surgical system work?

The ultra-modern Da Vinci technology allows the surgeon to perform a precise operation using a control panel to operate the four robotic arms. This advanced equipment has an optical system, which provides a 3D high-definition view.


Benefits of the Da Vinci surgical system

Regardless of how skilled the surgeon may be, the most common operations are always associated with possible side effects such as blood loss, pain, the risk of the healing process being disturbed and a long period of recovery due to the incisions of the skin.

The Da Vinci surgical system has the benefit of being minimally invasive, which has the following advantages: 

  • 3D view optical capabilities 
  • 10 to 20 times magnification for more precise identification of structures and tissue layers 
  • Instruments move like a human wrist 
  • Smaller and more delicate "hand" movements 
  • Elimination of natural tremor (trembling of the human hand)
  • Reduction in post-operation risks such as impotency and incontinence

Figures and statistics of the Da Vinci surgical system

Prostate Centre Europe treats thousands of patients annually from all over Europe making it the largest and most prestigious prostate centre in Europe. Chief physician Dr. J.H. Witt is the most experienced robotics surgeon in Europe. He leads a team of specialists including Dr. Wagner and Dr. Schütte both of whom perform surgery on approximately 5 patients per working day.

Quality evaluation

In the Netherlands, as well as other European countries, research is taking place to evaluate the different methods of prostate surgery. The different instruments and operations on offer, as well as the experience and expertise of the surgeons and their teams in the hospitals all play an important role in this. 

The post-operative results are judged on various aspects and often the oncological results are considered as the most important aspect. This in combination with the functional needs, which is the preservation of continence and potency, as well as the influence on the sex-life. In simple terms: the question of being able to have sexual intercourse.

Oncological results - Positive cut edge

After the prostate has been removed, it is analysed by the pathologist. It is important that there are no remaining cancer cells in the body. If the cut edge is positive (cut edge+) it is a sign that not all the cancer cells have been removed.

At the Prostate Centre Europe in Gronau, the pathologist can take a sample during the operation by means of a frozen section procedure, to determine the presence of cancer cells. This means the pathologist can constantly give information to the surgeon if it is desirable to cut and if so to what degree.

If it shows in the pathological report that there is positive cut edge present after the completion of the operation, a follow-up treatment will be discussed. This could be in the form of post-operative radiotherapy or hormone therapy. Depending on other factors such as the Gleason score of the removed prostate, the positive or negative findings of the removed lymph glands will all play a role in the decision of the follow-up treatment. Where the nerve-sparing operation is successful, the follow-up treatment still results in loss of potency in many cases.

The Prostate Centre Europe is shown to have the lowest percentage of positive surgical margins and the lowest incidence of all prostate removal operations in Europe (both compared to the same Da Vinci®-operations as well as other prostate removal operations).

In a stage 2 tumour (tumour is limited to the prostate) it has been shown that in only 3.1% of the cases treated by our team of specialists some cells had not been removed. This amounts to 23.0% in other cases of T3+ (tumour stage 3: tumour has grown through the encapsulation and a stage 4 tumour which due to its growth has become "stuck" to the surrounding structures).

Functional result

After the operation in Gronau, the patient immediately starts working on his recovery. The functional aspects; continence, potency and possibility of having intercourse are monitored during the next 24 months.

After 24 months of treatment, Prostate Centre Europe has the best results throughout Europe (both in comparison to same type of Da Vinci®-operations as well as other operating methods of prostate removal).

Continence

In 94.7% of all operations examined, we see that patients at the Prostate Centre Europe do not experience spontaneous urinary incontinence after the Da Vinci®-operation. (Time span: after 24 months). Incidentally a preventive bandage (1) is used for possible incontinence. (Scientific standard for continence preservation: use of 0 or 1 bandage for 24 hours.)

Potency

The potency remains overall (T2 and T3+) in nearly 70% (68.8%) of the nerve saving cases (time span: after 24 months).  (Scientific standard for potency preservation: SHIM – Sexual Health Inventory for Men Score ≥ 20). The high percentage of potency preservation is partially the result of the excellent oncological results, of which very few are a threat to potency and require further treatment.

Sexual intercourse

Intercourse is even possible in 88.8% of the cases, with the use of other resources (Viagra and vacuum pump).


Risks of the Da Vinci surgical system

The robot-assisted surgical technology usually leaves only very small scars. As a rule, the seam is stitched intradermally at the same level as the skin and protected with a "tissue regenerating plaster". We advise that physical exertion should be increased at a slow pace to allow the wound to heal more efficiently and promote the general healing process. In the first 2-3 weeks after surgery, you should avoid lifting heavy objects which weigh more than 10 kg (i.e. the weight of a bucket of water). Showering is allowed, and in fact desirable, one day after the operation. Medically it is not recommended to use so-called healing salves.

Experience of the urologist is of utmost importance

In a Da Vinci prostatectomy (prostate cancer treatment with Da Vinci) the experience of the urologist is crucial and this experience is determined on the number of treatments per year (learning curve). This is why Intuitive Surgical, the developer of the Da Vinci robot, uses the directive that a urologist must perform 250 Da Vinci operations per year to be able to operate independently. A urologist is only considered to be experienced after having performed 500 operations. If a urologist has performed a large amount of laparoscopic operations, he/she will acquire the necessary experience sooner.

Do you need more information?
If you would like more information about one of our treatments, please contact us.