Robot surgery offers prostate cancer patients hope

A new type of robotic surgery for prostate cancer that means patients recover in weeks rather than months is being pioneered by British doctors.

The technique involves an incision in the perineum – the undercarriage area between the legs – rather than in the front of the pelvis as in the standard NHS method.

Urologists at University College London Hospital are offering the op, and say the approach minimises blood loss and the risk of bowel damage, as well as reducing post-surgical complications such as urinary incontinence.

TV and radio presenter Bull Turnbull, who died last week of prostate cancer had spent his final years campaigning against the disease which

Traditionally, surgery for prostate cancer left patients suffering side effects such as erectile dysfunction and incontinence

The new robot assisted technique allows doctors to reduce the damage involved in treating the patient

Traditionally, surgery for prostate cancer left patients suffering side effects such as erectile dysfunction and incontinence

Accountant Mark McDerment, 51, who was one of the first patients to benefit, was dealing with work calls the morning after his operation and was discharged from hospital a day later.

The married father-of-three from High Easter, Essex, underwent surgery in March after being diagnosed with prostate cancer last year. ‘I feel I had a good recovery,’ he says. ‘Within a couple of weeks I was driving and taking the train to London again.’

The new robot assisted technique allows doctors to reduce the damage involved in treating the patient

About 52,000 men are diagnosed with prostate cancer in the UK each year and almost eight in ten men survive for a decade or more.

Last week the former BBC Breakfast host Bill Turnbull died almost five years after being diagnosed with advanced prostate cancer.

If the cancer is caught early, is slow growing and not causing symptoms, patients may simply be monitored with regular testing – known as watchful waiting and active surveillance – rather than given more aggressive treatment.

However, if the cancer is at a later stage, or if the tumour is aggressive and there’s a risk it could spread, surgery, radiotherapy and medication are options. These may be offered alone or in combination.

The prostate is a walnut-sized gland that sits beneath the bladder. Due to its location, treatments often carry the risk of causing incontinence. Surgery can also damage the nerves that supply the penis, leading to erectile dysfunction.

The operation to remove the prostate – known as a radical prostatectomy – is traditionally performed through a single large incision or keyhole surgery using multiple smaller incisions in the lower abdomen. The newest method is robot-assisted keyhole surgery. During the procedure, the surgeon controls a multi-armed machine that holds instruments, and advocates say it allows more precise movements.

Historically, prostatectomies were performed via the perineum, which allows a more direct route to the prostate. However, due to the position of the incision, it was difficult for surgeons to see what they were doing, and the method was all-but abandoned by the 1990s.

But with the advent of robotic keyhole surgery, experts have been able to revive the method.

Urological surgeon Christopher Ogden, who is part of the pioneering team developing the approach, says: ‘If you go in through the front of the abdomen, you have to travel more than a foot to get to where you need to be. You have to move the intestines out of the way and usually dissect the pelvic floor – the sheet of muscle that helps control bladder activity. This can affect continence. If you go in via the perineum, you only need travel a few inches. It’s a no-brainer.’

The method is particularly helpful for patients who have had previous abdominal surgery, such as an appendix removal or hernia repair, where a build-up of internal scar tissue can make entering via the front riskier.

Mr Ogden adds: ‘With standard surgery, patients are in hospital for two or three nights, and it takes six to eight weeks to recover. With the new approach, we’re keeping patients in for one night, but it could be done as a day case.

‘Men say they’re back to normal within weeks.’

Mr McDerment was told that he was an ideal candidate for the new technique as previous surgery to his abdomen had left a lot of scarring. Six months on and he feels mostly back to normal. The main issue has been with erectile dysfunction, which is extremely common after prostate operations.

‘Surgery has affected my love life – it has been life-changing in that respect,’ he says. ‘But I am having treatment for that, and I know it’s a matter of time and healing.’

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