What Is Minimally Invasive Surgery?
Minimally invasive surgery is a surgical procedure performed through small incisions -- usually made in the abdominal wall -- which results in the least possible harm to organs and surrounding tissue. The potential advantages of minimally invasive surgery for patients can be fewer complications, less blood loss, shorter hospital stay, and quicker recovery.
When treating a man with prostate cancer using minimally invasive surgery, our goals are to cure the patient of cancer and preserve his quality of life, both in the short term -- easier recovery after the operation -- and in the long term -- preservation of continence (ability to control urination) and potency (ability to have an erection).
More than half of all radical prostatectomy operations (surgery to remove the prostate gland) are performed at Memorial Sloan-Kettering using minimally invasive techniques, with conventional laparoscopic or robotic-assisted laparoscopic surgery. (See below for descriptions of these techniques.)
Laparoscopic Radical Prostatectomy
One minimally invasive surgical approach used at Memorial Sloan-Kettering to treat prostate cancer is laparoscopic radical prostatectomy. The surgeon begins by making a small incision around the navel in order to insert a thin, lighted telescopic camera, called a laparoscope, into the body. The camera projects a magnified, high-definition image of the surgical area. The operation is performed with specialized surgical instruments, which are delicately manipulated to remove the prostate, seminal vesicles, and lymph nodes, and then to reconstruct the urinary tract.
Nerve-sparing techniques to preserve potency are used during this surgery to preserve the tiny nerves and vessels that are attached to the prostate and are involved in the control of erections. The degree to which nerve sparing can be performed is, in part, dependent on the size and location of the cancer within the prostate. Tailoring this aspect of the surgery to the each patient is optimized based on a very thorough pre-surgical evaluation and treatment plan, as well as the extensive experience of our surgeons, some of whom pioneered this laparoscopic operation.
Robotic-assisted Laparoscopic Radical Prostatectomy
To perform robotic-assisted laparoscopic operations, specially-trained surgeons use an advanced robotic device -- called the daVinci® Surgical System -- to assist with the procedure. Seated at a multifunctional console located within the operating room, the surgeon views the area of the operation on a screen via a magnified, three-dimensional, high-definition visual system. This allows the surgeon to see very fine anatomic detail that would be difficult to visualize without such optical enhancement.
The operation is performed by the surgeon at the console using hand, finger, and foot controls with the robot precisely copying every movement of the surgeon. The robot increases the precision of the surgeon's motions by scaling down each movement, reducing them by half or even three quarters. This allows the surgeon to make much finer movements then would be possible free handed as in open or traditional laparoscopic surgery, while focusing on the very same goals of cancer removal, nerve preservation, and maintenance of normal urinary and sexual function.
Robotics at Memorial Sloan-Kettering
Across the many types of cancer that our experts treat at Memorial Sloan-Kettering, 22 surgeons are currently trained in robotic surgery. They performed more than 700 operations in the last year using the robot. Specific to prostate cancer, we have nine surgeons who perform robotic surgery at Memorial Sloan-Kettering. Our specialization in robotic surgery builds upon the Center's vast experience with open and laparoscopic surgery. Our goal is to utilize, evaluate, and expand this technology to its maximum potential, incorporating the very latest developments in the field and tailoring this technology specifically to the care of cancer patients.
Who Is a Candidate for Minimally Invasive Surgery?
Most patients who are candidates for open cancer surgery also qualify for minimally invasive surgery. At Memorial Sloan-Kettering, we recommend that rather than choosing one procedure over another, patients should first select an experienced surgeon whose treatment approach is the most appropriate for his particular cancer. Surgeons generally specialize in either traditional open surgery or minimally invasive surgery. If a patient is unsure which procedure is most appropriate for him, he will have ample opportunity during his evaluation and consultation to learn more. Our surgeons work together on a regular basis, continually reviewing, discussing, and refining these various procedures with the singular goal of producing the best possible outcomes for each patient.
Our Results
Our Publications Read journal articles from our minimally invasive surgery experts 
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When treating prostate cancer, studies show that the more experience a surgeon has, the less likely the cancer will return (recur).1 2 Therefore it is extremely important to choose a surgeon who is highly experienced in the surgical modality that he or she is using for the operation.
At Memorial Sloan-Kettering, we carefully evaluate the results of all surgical procedures, especially as new instruments and new methods are developed, in order to determine if some patients would benefit most from one technique or another. We are committed to leading the advancement and appropriate use of all forms of surgery in the care of patients with prostate cancer.
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Our investigators have conducted a number of studies to evaluate the results, advantages, and specific techniques of laparoscopic and robotic-assisted radical prostatectomy surgery. There are ongoing studies to compare short- and long-term rates of cancer progression and the functional benefit of open, laparoscopic, and robotic-assisted laparoscopic radical prostatectomy. This is a major focus of our outcomes research at Memorial Sloan-Kettering.
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A growing body of research has shown that results of laparoscopic and robotic assisted surgery are comparable with those of open surgery. This is demonstrated both in local cancer control -- measured with surgical margins and rates of cancer recurrence -- as well as quality of life issues. Almost all men who are candidates for the traditional, "open" radical prostatectomy are also candidates for a laparoscopic or robotic-assisted laparoscopic radical prostatectomy. Memorial Sloan-Kettering studies show that even patients with an aggressive prostate cancer will have an equal chance to be cured of their prostate cancer with a minimally invasive approach when properly performed.3 4
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We also examined the role of robotic surgery in patients who have had prior abdominal and pelvic surgery finding that this surgery could be safely and effectively performed in most circumstances.
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Another study utilized video review documentation and pathologic findings to understand how this information can be best incorporated to improve surgical technique and achieve appropriate surgical margins.5
Our Team of Experts
Our urologic surgeons who are specialized in minimally invasive surgery are recognized worldwide for their skill and expertise in treating tumors of the prostate.
Select from the list below to learn more about our urologic surgeons and their experience, education, training, board certifications, current publications, and specific areas of clinical expertise.
