Back on track: Life after robotic-assisted prostate surgery
At 6 a.m. on January 14 — the day after an intensive operation to remove his entire prostate gland and 12 pelvic lymph nodes — Allan Polley got out of his bed at Community Hospital of the Monterey Peninsula and walked four laps around the nursing unit.
Polley went home that same afternoon and took one Tylenol® before bed that night. A month later, with his successful surgery for prostate cancer behind him, he was going for regular hikes and making plans to resume running and playing golf and to return to his hobby, dog-agility training.
The retired Marine lieutenant colonel said his experience was smooth and without significant pain, thanks to a highly skilled surgeon using state-of-the-art technology. Dr. Harsha R. Mittakanti performed the operation, a radical prostatectomy and bilateral pelvic lymph node dissection, through robotic-assisted surgery with the da Vinci Xi surgical system.
“I just feel so fortunate that the medical community was able to make this kind of treatment available to me,” Polley says.
Community Hospital began offering robotic-assisted surgery in late 2019. Mittakanti and three other surgeons perform surgeries with the da Vinci Xi robot. During robotic surgery, the surgeon is in full control, operating from a console about 10 feet away from the patient, while the rest of the surgical team is at the bedside.
“Robotic surgery is a fusion of both laparoscopic and ‘open’ surgical techniques, where a surgeon can have precision and control combined with the smallest incisions possible,” says Mittakanti, a urologic surgeon and medical director of the robotic-assisted surgery program at Community Hospital. “Robotic surgery provides me with a superior field of vision — an ultra high-definition, 3-D view of all the organs, blood vessels, and nerves in the abdomen and pelvis.
“The arms of the robot mimic my hand and wrist movements exactly, allowing me to operate as if my own hands were inside the body. Essentially, I can move my hands in and out, grasp things, and move my wrists in all different directions.”
The small incisions can result in less blood loss, faster recovery, and less pain, meaning less need for narcotic pain relief. Polley says he took four Tylenol tablets on his second day at home and hasn’t needed any since.
Polley’s high-risk cancer was diagnosed after a sky-high prostate-specific antigen (PSA) test score raised concern. Subsequent tests — blood analysis, two MRIs, a bone scan, and a biopsy — confirmed a problem that needed to be addressed.
His urologist, Dr. Andrea Chan, recommended he see Mittakanti, her colleague at Montage Medical Group, to discuss robotic-assisted surgery. The technology enables precise removal of the prostate, and is effective at sparing nerves attached to the prostate gland that are crucial to sexual function.
Mittakanti spent six years at Stanford University, where he trained in traditional open surgery, laparoscopic surgery, and robotic surgery.
“By the time I came out of Stanford, I felt like robotic surgery was my niche, and I decided to follow my passion,” he says.
Mittakanti then did an advanced robotic surgery fellowship at Swedish Medical Center in Seattle with Dr. James Porter, regarded as one of the world’s preeminent robotic surgeons.
“It was a high-volume, high-acuity training regimen for a full year. We basically were doing robotic surgery every day,” Mittakanti says. “That experience not only affirmed my love for robotic surgery, it also provided me with the ability to take on more challenging cases.”
Polley’s surgery revealed that 80 percent of his prostate was malignant, and the cancer had aggressively spread to 4 of the 12 lymph nodes that were removed with the gland. Mittakanti removed the prostate and lymph nodes, sparing nerves and with and only minimal alterations to Polley’s urethra. Polley says he has experienced virtually no urinary incontinence, which can be a side effect of prostatectomy.
“Whether a patient is a good candidate for robotic surgery depends on the patient, the surgeon, and the pathology,” Mittakanti says. “Allan was a lower surgical risk because he takes good care of himself. If, on the other hand, someone is very frail, or has other health problems, such as morbid obesity or heart and lung issues, it might not be the best course of action.”
Robotic surgery can be performed for most prostatectomies: Mittakanti estimates that about 80 percent are done robotically today.
At Community Hospital, robotic surgery is currently being used for urology and gynecology procedures. Urologic issues such as various types of cancer, urinary blockage from benign prostate hyperplasia (BPH), or even urinary reconstruction can be treated robotically. Robotic surgery for gynecologic ailments such as fibroids, endometriosis, and cancer is also offered.
“We can use robotics on a cancerous kidney, which allows us to save most of the kidney in a lot of cases,” Mittakanti says. “Previously, it was common to take out the entire kidney because removing part of it was just too difficult.”
Polley’s current prognosis indicates he might not need radiation treatments or hormone therapy.
“I want people to know that I’ve been through prostate cancer and it’s not a death sentence,” he says. “I want to get the word out that this amazing treatment is available here, and it is a gift.”