ROBOTIC PROSTATECTOMY

Cure rates for robotic and traditional prostatectomy are best when performed by an experienced surgeon. A prospective multicenter comparison between open and robotic surgery showed robotic surgery subjects had less pain, less blood transfusions, less urethra scarring and less blood clots.

The robot eliminates much of the variability in open surgery, greatly reducing risks as compared to traditional open surgery, even when performed by an experienced surgeon.

During his extensive training and fellowship, Dr. Kella performed dozens of open and robotic surgeries. “In open cases, there are many instances in which the view of a patient’s anatomy is obstructed, especially during prostate surgeries because the area is so small,” states Dr. Kella. “For example, if a patient has a large pelvic bone, sometimes there’s just no way you can see the prostate around that bone during a traditional open-technique surgery. Before robots were available, we were trained to just remove the prostate by feel because that was our only option. When you can’t see what you’re operating on, it greatly increases the likelihood and frequency of bleeding, which is very risky to the patient. So risky, in fact, that if patients begin bleeding, our primary goal as a surgeon actually changes. We have to stop the patient from bleeding at that point, which can force a case to be completed in haste – compromising both muscle preservation and nerve sensation.”

“Having a robot with tiny little fingers that can now gently and easily travel right around that pelvic bone and give me a 3-dimensional view of the prostate is simply incredible. The precision it affords you is actually just amazing to watch – that’s one reason I recorded so many of my surgeries. Initially, I recorded them so that I could re-watch them and perfect my technique. Now I use the videos a lot to teach newer surgeons the techniques I have learned and developed over the years for different situations. It does take a really long time to become an expert at using the robot, but once you and your surgical team do, the outcomes really are priceless.”

Urinary leakage is one of the most common side effects of prostate cancer surgery. As a result, many patients have to wear a pad for a period of time following their surgery. 

In the following study, the extent of post-surgical urinary leakage was measured among  prostate surgery patients. The other surgeons in the study have performed  robotic prostatectomies, but were not as experienced as Dr. Kella. The study was a subset analysis, but sheds light on surgeon differences.

Results Summary:

One month after surgery, 67% of Dr. Kella’s patients report no urinary leakage or such slight leakage that it only requires use of 1 pad per day. Alternatively, the majority of patients (64%) who underwent surgery with a less experienced surgeon were experiencing excessive urinary leakage requiring 2 or more pads per day.

By six months after surgery, fewer than 6% of Dr. Kella’s patients report concerns with urinary leakage. 15% of other surgeons' patients were  still reporting excessive leakage requiring 2 or more pads per day.

St Lukes Baptist is in San Antonio's medical center. Patients have been impressed with the hospital and its well appointed private rooms.

Yes. We would be thrilled to see you for prostate cancer follow up. If your urologist referred you to see us, you can continue your follow up with him or her. 

However, if you need a urologist, we can see you personally or via telemedicine if your insurance allows it.

Yes. We have an all inclusive rate, which is extremely competitive. Our charge (as of January 2019) is $25,000. This covers the surgeon, assistant, anesthesia, pathologist, and hospital for up to a 3 day stay. Your preoperative visit and post operative visit are also covered. You should not see any other surprise charges.

Of course. We see patients routinely from outside South Texas. We have discounted rates with Staybridge Suites close to the medical center. You can go home if you like the day after surgery by plane or automobile. We can even manage post operative care with your local doctor and telemedicine if needed.

The foley is removed after one week. Removing it sooner increases the rate of being unable to urinated. It takes about a week for the healing and swelling to resolve. Nearly all patients don't need any pain pills for the catheter!

You will be provided with surgery instructions from the front desk during scheduling. The day before the surgery you must begin a liquid diet. This includes smoothies, milk, tea with lemon and sugar, fat free broth, clear carbonated beverages such as 7- UP, Sprite, gelatin, clear apple   juice, strained fruit juices and water. You will be required to drink 3 (8oz) glasses of water. No eating or drinking past midnight except for high blood pressure medication.