No team has more experience with robotic prostatectomy, a procedure that not only removes the cancer, but has a high probability of preserving sexual function and urinary control. Henry Ford has performed nearly 5,000 robotic prostatectomy surgeries - more than any other hospital in the world.
How Vattikuti Institute Prostatectomy Compares to Open Prostatectomy
There are many ways to treat prostate cancer, and each method has its own advantages. We are sharing with you our experience with both robotic prostatectomy and open prostatectomy so that you can make an informed decision.
Open Surgery vs. VIP Robotic Surgery
Measure
Open Surgery at Henry Ford
Robotic Surgery (VIP) at Henry Ford
No detect-able PSA at 5 years
86 percent
97 percent
No pads needed
60 percent
96 percent
Erections firm enough for intercourse
66 percent
97 percent*
No complications
85 percent
98 percent
Patient response to Pain Score
7
3
No transfusion in surgery
89 percent
100 percent
600
406 (67 percent)
552 (92 percent)
Time and again, our studies have demonstrated that the Vattikuti Institute Prostatectomy (VIP) is superior to open surgery. On this scorecard, the best possible score for each variable is 100, for a possible perfect total score of 600. Open surgery receives a score of 406, while the VIP receives a score of 552.
"Best in Class" Open Surgery
VIP at Henry Ford3
80 percent
74 percent
94 percent
Pain3 (1-10, lower score=less pain)
474 (79 percent) -Theoretical
552 (92 percent) -Actual
1 J Urol. 2008 Jun;179(6):2207-10.Urol; 2 J. Urol, 166(5):1729, 2001; 3 BJU Int. 2003 Aug;92(3):205-10, J Endourol. 2003 Nov;17(9):785-90, and VUI data file; 4 J. Urol, 156(3):1077, 1996; 5 J. Urol .174:2291, 2005; BJU Int. Vol. 97:467, 2006 ; Urology Vol. 66:261, 2005
This scorecard uses the same parameters; however, this time we compare Vattikuti Institute Prostatectomy (VIP) to open surgery performed by the best surgeons in the United States. The best in class data do not represent the experience of a single surgeon but of multiple surgeons.
These are the results that could hypothetically be achieved if all the best open surgeons in the world were put in a single room to operate on you. No single surgeon has published such good results. Just like a golf scramble, the total score is significantly better than would be achieved by a single surgeon because you're taking the best shots on the way to each hole.
We feel the second scorecard is less reliable than the first scorecard, because the "best in class" data are based on published results from other surgeons. There may be slight differences in how surgeons collect their data, and there may be results that have not been published.
Patients at the Vattikuti Urology Institute have told us they are most concerned about the following factors when deciding what type of prostate cancer treatment to undergo:
Cancer Removal At Henry Ford, surgeons tend to operate on more aggressive prostate cancers than at other institutions. Yet, with the Vattikuti Institute Prostatectomy, less than 4 percent of men had a PSA recurrence at five years after prostate surgery.
Whether a cancer can be completely removed depends on several factors - including the skill of the surgeon, the tumor volume (how much cancer there is) and tumor grade (how abnormal the cancer looks under a microscope). Any surgeon, no matter his or her skill, will not be successful in removing all the cancer if the cancer is particularly aggressive.
Success in eliminating cancer is measured in terms of "PSA recurrence" - the same PSA test that probably led to your cancer diagnosis in the first place. The American Urological Association defines a value of >0.2, if confirmed with a second value, as a PSA recurrence after prostatectomy. If there is no PSA recurrence, you are safe. If the PSA does come back, you may still be safe, but about 10-20 percent of the time, the cancer will spread to other parts of the body, and it is better to get additional treatment, such as radiation, hormones or chemotherapy.
Urinary Continence The majority of Vattikuti Institute Prostatectomy patients have had total urinary control within 24 hours. Patients who undergo the VIP regain continence much faster than patients undergoing open prostatectomy.
When the prostate is removed, one of two muscles that control urination also is removed because this muscle lives in the prostate. Until the second muscle is able to develop, a patient may leak urine.
Incontinent patients wear pads to contain their urinary leakage. For patients having robotic prostatectomy with our catheter-free technique, 92 percent are continent at one month and 96 percent are not wearing pads at six months. For patients undergoing open prostatectomy, 25 percent are dry at eight weeks and 60 percent are not wearing pads six months after surgery.
Erectile Function At the Vattikuti Urology Institute, 97 percent of patients undergoing a nerve-sparing robotic radical prostatectomy had return of erectile function.
One very common side effect of prostate cancer treatment - surgery, radiation, or hormone treatments - is erectile dysfunction, or the inability to have and sustain an adequate erection for sexual intercourse. While sexual desire, orgasm and sensation remain the same, most men notice a change in the quality of their erections because the nerves and blood vessels required for erections often are stretched or cut during prostate surgery.
Over a period of two to three years, erections should return. The rate of return depends on emotional factors, age, the partner, the level of current sexual activity and whether the surgeon was able to preserve the nerves.
Among Vattikuti Institute Prostatectomy patients, 97 percent who underwent nerve-sparing robotic prostate surgery had return of erectile function. About 84 percent of men responded that they were "back to normal," while the other 13 percent had erections strong enough for intercourse, but weaker than before surgery. As with continence, VIP patients appear to regain erectile function faster than patients undergoing open surgery, and it is likely that these results will improve with time. There also are many methods to improve sexual function, and we encourage using these.
Catheter-free Recovery For most men, one of the biggest complaints about prostate surgery is discomfort from the urethral catheter. To address this issue, Dr. Menon has developed a surgical technique that eliminates use of the catheter. Urine is drained instead through a small tube, much like an IV tube, through the abdomen. The response from patients has been truly remarkable. When given the choice, 98 percent of our prostatectomy patients prefer this option. More than 400 men have undergone this procedure at the Vattikuti Urology Institute, giving us the largest patient experience with this technique. Make sure you ask us if this option is right for you.
Safety Among VIattikuti Institute Prostatectomy patients, 98 percent had no complications, and 85 percent of patients undergoing the open procedure had no complications.
No matter how routine, there are risks to every operation. However, those risks are reduced with the VIP procedure. Complications during surgery can include a hernia at the "port," where the scopes are inserted into the body, post-operative bleeding, a deep venous thrombosis or blood clots that develop in the veins of the legs and the pelvic region.
Pain Patients who had the Vattikuti Institute Prostatectomy generally have less pain compared to patients who had the open prostatectomy.
All patients are asked to complete a pain evaluation test upon completion of surgery. A score of "1" indicates no pain at all, and a score of "10" indicates the worst pain imaginable. On average, patients undergoing the open procedure at Henry Ford indicate an average pain score of "7," and VIP patients indicate an average pain score of "3."
Blood Loss The risk of blood loss with the Vattikuti Institute Prostatectomy is much lower compared to open surgery.
The prostate has multiple large blood vessels surrounding it, and bleeding during surgery is a common risk. Sometimes, blood loss is so significant that patients need a transfusion to replace what is lost. This has happened in 11 percent of patients having open prostate surgery at Henry Ford. However, no VIP patient has had to undergo a transfusion due to excessive blood loss.
Even though most patients undergoing open prostatectomy do not require a blood transfusion, most of them are anemic when they go home. More than 97 percent of our robotic prostatectomy patients are not anemic at time of discharge and are able to resume normal activity more quickly than the open surgery patients.
