Game-changing prostate cancer surgery

We’re home to the South Bay’s longest-running robotic-assisted surgery program.

When urologist Garrett S. Matsunaga, MD, co-founded the robotic-assisted surgery program at Providence Little Company of Mary Medical Centers San Pedro and Torrance in 2006, he viewed the technology as a game changer, particularly for prostate cancer surgery.

“The robotic technology allows urologists to remove the prostate laparoscopically for prostate cancer and do it better than when we had to perform an open procedure,” he says.

Laparoscopy, also known as keyhole surgery, offers numerous advantages. “Through tiny incisions of 5 to 8 millimeters, we’re able to introduce instruments into the abdominal cavity to do various procedures,” says Dr. Matsunaga. “The benefit of that is, smaller incisions equate to less pain, shorter hospitalization, faster recovery and less blood loss.”

A challenge with radical prostatectomy has been the walnut-size prostate’s location deep in the pelvis. “You are operating in a very narrow space, and with traditional laparoscopic instruments that could not allow rotation at the wrist, it was technically so difficult that very few surgeons could do a good laparoscopic prostatectomy,” says Dr. Matsunaga.

At Providence Little Company of Mary, highly skilled surgeons now perform thousands of robotic-assisted radical prostatectomies each year. “One of our strengths is we have the longest-running robotics program here in the South Bay,” says Dr. Matsunaga. “Providence had the vision to invest in this technology, which now is the standard of care. They were one of the leaders in acquiring this technology and supporting their surgeons in getting trained and using this technology effectively.”

Additional strengths include an experienced operating room staff and postoperative care team that Dr. Matsunaga describes as “second to none.” “It is the whole team that creates a successful robotics program,” he says.

AN EXTENSION OF SURGEONS’ HANDS

Dr. Matsunaga thinks of the robotic da Vinci Surgical System, which has wristed instruments that can rotate 270 degrees, as an extension of his hands. “It gives us the ability to operate with greater precision compared to traditional laparoscopic instruments,” he says. “The system has two cameras—one for the left eye, one for the right eye—and that affords the surgeon depth perception, so you have a three-dimensional view. We have better magnification with the robotic camera as well.”

When removing the prostate, surgeons must be very careful, because it sits next to the urinary sphincter and on top of nerves that affect sexual function. “The challenge of radical prostatectomy is you have to remove the entire prostate and not leave any cancer behind, but you have to do it in a manner that protects the integrity of the sphincter so that the man does not lose urinary control, and then you have to carefully separate the prostate away from these nerves to preserve sexual function,” says Dr. Matsunaga.

He refers to these objectives as the trifecta of a successful radical prostatectomy. “Robotics allowed us to successfully do this technically difficult surgery in a very narrow space down in the pelvis and achieve this trifecta in most cases,” he says.

Before surgery, Dr. Matsunaga discusses risks with patients. “The risk of leaking urine long-term—six months to a year out—is probably less than 1%,” he says. “The risk of erectile dysfunction depends on several factors, including the individual’s sexual function prior to surgery as well as the extent of the cancer, which sometimes affects the nerves that make erections possible.”

“Every surgery has risks, so we also talk about the standard risks of surgery,” says Dr. Matsunaga. “Any time we are doing laparoscopy, there is some blood loss, although our blood loss is low. Patients requiring a transfusion for blood loss after a laparoscopy is essentially 0%. Risk of infection is also very low, probably less than 0.1%.”

After surgery, patients typically spend one night in the hospital and are discharged with a catheter, which is removed after one week. “By week two we are often reminding our patients, ‘I know you feel well, but no heavy lifting and no strenuous activity for at least four weeks,’ because you want to let everything heal,” says Dr. Matsunaga. “Patients heal so much faster now with the robotic approach.”

For more information on robotic-assisted prostate surgery and other types of robotic-assisted surgery, call 844-925-0942.