Our philosophy is to maximize cancer control rates without sacrificing the patient's quality of life with regards to potency and continence. Furthermore, we strongly believe that both cancer control and quality of life outcomes are more dependent on the surgeon's knowledge of the natural history of prostate cancer growth and spread in the prostate, the intricate surgical anatomy of the prostate and surrounding structures, and the surgeon's experience in this specialized type of surgery. Less important are the tools or methods used to perform the surgery.
With this philosophy in mind, we have performed over two thousand radical prostatectomies over the past 15 years and are recognized world leaders in the field of the treatment of localized prostate cancer. We have published extensively regarding innovative ideas and techniques related to prostate cancer screening, prostate biopsy, prostate nomograms, novel markers to predict prostate cancer outcomes, nerve sparing radical prostatectomy, sural nerve and collagen tube grafting, the proper role for standard vs. extended lymph node removal during surgery, and the importance and specialized techniques of minimizing positive surgical margin rates for tumors of all stages and grades.
Through a careful process of quality improvement that includes systematic capture of cancer control and quality of life data on every patient beginning prior to their surgery, and continuing at every follow-up visit afterwards, we continue to accumulate a comprehensive database that allows us to measure the impact of even the smallest changes in technique, keeping those that demonstrate a clear benefit and discarding those that don’t add significantly to the quality of the results. Some key maneuvers that we have validated using this approach include both anterior and posterior reconstruction of the urinary rhabdosphincter, maneuvers that reconstruct both the natural suspension and angle of this important sphincter, measurably speeding the rate of return of urinary continence after Robotic Prostatectomy.
Through this methodical, data driven process, we have made a myriad of additional subtle changes, resulting in unique techniques for performing both open and Robotic Prostatectomy. We are one of only a few centers that perform the surgery without actually entering the abdominal cavity. We believe this makes the surgery safer for the patient, speeds the patient's recovery after surgery allowing him to return to normal activity and work more rapidly, and avoids potential complications for the patient down the road related to intra-abdominal surgery. We have now demonstrated in a new study soon to be published that we have maintained our low positive margin rates, traditionally seen with our mini-incision open radical prostatectomy technique with robotic laparascopic-assisted radical prostatectomy. Furthermore, we have adopted approaches that minimize the use of electro-cautery near the neurovascular bundles to improve the quality of our nerve sparing techniques. Careful study, using questionnaires, of all patients who have had surgery with us, has led us to make fine adjustments in our surgical technique that have led to clear, measurable improvements in our outcomes. Finally, regardless of the approach (open or robotic), we work intensively with all patients post-operatively to improve the rate of return of both erectile function and urinary control.
What is Robotic Surgery? | Preparing for Surgery | Axogen Avance Nerve Graft