Robotic Prostate Surgery at Mount Sinai
The Milton and Carroll Petrie Department of Urology at Mount Sinai offers one of the most advanced and comprehensive robotic prostate programs in the nation. Our robotic prostate surgery program is led by Dr. Ashutosh (Ash) K. Tewari, Chairman of the Department of Urology and one of the world’s foremost researchers and surgeons in the field of prostate cancer. A pioneer of the da Vinci® robotic surgery for prostate cancer, Dr. Tewari has performed more than 5,500 robotic prostatectomies (surgery to remove the entire prostate), making him one of the most skilled and experienced robotic surgeons in the world – expertise that is especially important if you are considering robotic prostatectomy, where successful surgery depends more on the skill and experience of the surgeon than on the technology. Dr. Tewari performs all aspects of the surgery himself.
Advanced Techniques for Better Outcomes
The robotic prostate surgery approach used at Mount Sinai is known as ART™ (Advanced Robotic Technique) prostatectomy, or ART for short. It is a highly effective approach to treating prostate cancer in select patients that Dr. Tewari and his team have developed and refined over the past decade based on the thousands of surgeries they have performed, their discoveries in prostate anatomy (Dr. Tewari was the first to identify the nerves responsible for erectile function as a neural hammock), and other leading-edge research.
The ART approach consists of not just one technique but a group of techniques. Among the approach’s many distinct features and benefits are:
- Precise diagnosis through state-of-the-art evaluation: We use a new technique known as targeted biopsy to diagnose prostate cancer. This approach fuses highly detailed MRI (magnetic resonance imaging) with real-time ultrasound using the Artemis device. The procedure typically takes between 15 to 20 minutes and is done in our office under local anesthetic. It provides highly accurate information about the location of cancer and its relation to nerves and sphincters. Mount Sinai is one of three medical facilities in New York City to have the Artemis device.
- Cancer control: ART has proven to provide lower margin rates (less residual cancer) than other robotic techniques performed by leading robotic surgeons (less than 10 percent positive margins versus 10 - 30 percent). As a result, there is less need for radiation and hormone therapy post-surgery, and men have less reason to feel anxious about future rises in their PSA. Our program is one of the few in the world where pathologists are on standby to provide real-time, rapid interpretation of the entire prostate margin, rather than of small pieces of tissue when they are taken for a frozen tissue biopsy. This rapid pathology reassures the patient that the cancer has been removed as we work to preserve nerves.
- High rates of erectile function recovery: The aim of ART is to preserve every nerve fiber responsible for the fine balance between erection, orgasm, and bladder function. In order to protect the delicate nerves involved (which do not handle heat, traction, or manipulation very well), we use a nerve-sparing, completely athermal technique (no use of cautery or heat energy) during robotic prostatectomy – a technique pioneered by Dr. Tewari and his team. Fully 87 percent of patients who experience normal sexual functioning and are candidates for nerve-sparing, return to normal sexual function after ART surgical treatment. Learn more about robotic prostatectomy surgical outcomes at Mount Sinai
- Faster return to urinary continence: ART incorporates a novel surgical technique to minimize or prevent urinary leakage. It involves reconstruction of the supporting structures responsible for urinary continence that are typically either removed or disorganized during removal of the prostate. Ninety-seven percent of our patients who are continent before the surgery are continent 18 months after undergoing the procedure. Learn more about urinary control after robotic prostate surgery
In addition, with the ART technique, patients and their families have been able to benefit from faster convalescence, short hospital stays, small incisions with less scarring, significantly less blood loss during surgery, and less pain following surgery, compared to other prostate removal procedures. The majority of our patients are discharged and return home within 24 hours of their robotic surgery.