Robotic Prostate Surgery

Robotic Prostate Surgery

Dr. Naveen Kella at The Urology Place is a fellowship-trained, nationally recognized leader in robotic prostate surgery in the United States. One of the nation’s top robotic prostate surgeons, Dr. Kella has performed over 2,200 robotic prostatectomies from start to finish, ranking him one of the most experienced surgeons not only in Texas, but in the entire country.

If you have been diagnosed with prostate cancer, you may have heard about robotic prostate surgery, or robotic prostatectomy. Many patients initially feel overwhelmed with a prostate cancer diagnosis. At The Urology Place, we specialize in the treatment of prostate cancer and work with our patients to help them make informed, appropriate decisions for their particular case. After treating thousands of prostate cancer patients, we have become known for our superior prostate cancer outcomes, most notably our patient outcomes with robotic surgery. Dr. Naveen Kella performs 100% of the robotic prostatectomies at The Urology Place.  Dr. Kella and his expert surgical team have been working together for over 10 years, making it one of the most specialized teams in the nation for prostate cancer removal. The team employs specialized procedures to avoid heat from cautery and minimize tension, two key factors in recovery.

What is Robotic Prostate Surgery?

Robotic technology gives doctors the ability to perform delicate surgery through small incisions with enhanced vision and precision. The instruments and surgical tools on the end of the robot closest to the patient move like fingers. The surgical robot scales down a surgeon’s hand movements to allow finer, more precise movements while eliminating natural tremor. A high-definition camera provides exceptional 3-D vision to the surgeon not possible with traditional surgery. Dr. Kella uses the newest Intuitive Surgical daVinci Si and Xi robots. These second and third generation systems provide a wide viewing field and high-definition display, allowing the use of improved instruments and precise controls. The Si is the workhorse for pelvic surgeries like prostate cancer surgery, while the Xi is perfect for complex, multi-quadrant surgeries.

What are Some Advantages of Robotic Prostate Surgery?

Robotic prostate surgery requires just five incisions, each less than three-quarters of an inch long. Four lower incisions are made to provide access for the robot’s arms. A slightly larger fifth incision is made above the navel for both camera access and prostate removal. In comparison, traditional prostate cancer surgery requires a large, six to eight inch cut. Dr. Kella at The Urology Place plans and tailors each surgery to the specific patient to ensure maximum effectiveness and minimal scarring. “Sometimes, we will remove lymph nodes around the prostate. We do our utmost to save as much muscle and nerve tissue as possible. Of course, the cancer removal is the primary goal.” Recovery time from robotic prostate surgery is one to three weeks, compared to six to eight weeks for traditional open prostate surgery.

What is Propep Nerve Monitoring?

Propep nerve monitoring is a highly advanced technical device that Dr. Kella uses for real-time feedback on a patient’s nerve fiber response during surgery. “When you have the ability to detect even the slightest changes in nerve function as you are performing surgery, you can then carefully tailor your surgery to the patient in a way that best preserves their sexual and urinary function,” states Dr. Kella. And his outcomes show it. Studies show that compared with other surgeons, Dr. Kella’s patients experience some of the fastest recovery times in terms of regaining urinary control and sex function.

Dr. Kella has performed over 250 cases using the Propep monitoring system, where he has assessed, analyzed, and recorded nerve responses and function during surgery. Because of his extensive experience and understanding of nerve function response, he is able to speak with patients immediately after surgery as to the success of their nerve preservation. While the potential to achieve optimal results depends upon the individual patient, the odds of full recovery are increased when an experienced surgeon and team perform the procedure.

How Does Robotic Prostate Surgery Compare to Open Surgery?

Cure rates for robotic and traditional prostatectomy are good when performed by an experienced surgeon. Data indicate that cancer removal may be more thorough with robotics, increasing the likelihood of cure. 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 360-degree view of the prostate is simply incredible. The precision it affords you is actually just amazing to watch – that’s one reason I record 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.”

Why should I see Dr. Kella for a consultation?

Unlike many surgeons in this field, Dr. Kella carefully monitors all of his robotic prostate surgery outcomes and grades the impact of techniques. With experience and outcome studies, results can keep improving, even for a highly talented and seasoned surgeon. This fact is backed up by literature showing that prostate surgery outcomes improve with experience. Dr. Kella has performed over 2,200 procedures, making him one of the most experienced prostate surgeons in South Texas. Dr. Kella has presented and shared many videos with his colleagues, some of which are available on this page. There is also a link to an actual surgery available here.  The comments section features many positive comments from consumers as well as other physicians.

Dr. Kella at The Urology Place believes in the power of an experienced surgeon and team.

Review of the literature on robotic prostate surgery provides one consistent message: choosing the right surgeon and team is imperative to a patient’s overall outcome and cure. Fortunately, Dr. Kella realized this early in his career and understands the importance of having an excellent team.  As such, Dr. Kella has performed the vast number of his robotic prostate surgeries at one hospital, St. Luke’s Baptist Hospital in San Antonio’s South Texas Medical Center. The same surgery assistant, operating room nurses, and hospital nurses have been involved in every step of care for thousands of patients. The increased quality and consistency of care that this team provides continues to draw patients from across Texas, the southern United States, and even Mexico.

Did you know?

Dr. Naveen Kella performed the first robotic prostate surgery in South Texas.

St. Luke’s Baptist Hospital was the first hospital in San Antonio to start a robotics program. Teaming with St. Luke’s, Dr. Kella performed the first robotic prostatectomy. Today, Dr. Kella’s experience makes him one of the top robotic prostate surgeons in the world. His experience and expertise draw dozens of fellows, surgeons, and students to his operating room so that they can observe and learn from him.

A Case Study: Urinary Leakage After Robotic Prostate Surgery

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. Pads have to be switched out throughout the day as they are filled with urine.

In the following study, the extent of post-surgical urinary leakage was measured among a subset of robotic surgery patients. The other surgeons in the study have performed many robotic prostatectomies, but are not as experienced as Dr. Kella. The purpose of the study was to see if there was a measurable improvement in outcome with increased surgical experience. In other words, could a surgeon, through extensive study and experience, develop skills that could measurably improve patient outcomes? Specifically, would Dr. Kella’s patients experience less urinary leakage after robotic prostatectomy than patients of less experienced surgeons?

Study results indicated that experience and skill can reduce a patient’s chance of side effects. In this case, Dr. Kella’s patients experienced milder, less lengthy cases of urinary leakage than other surgeons in the study.

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 are 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, yet 85% of other surgeons patients are still reporting excessive leakage requiring 2 or more pads per day.

The results of this study were conclusive: Experience Matters.

One Month after Prostatectomy Three Months Six Months
Dr Naveen Kella 67% wear only 0 or 1 pads per day 90% 94%
Other Surgeons in Study 64% wear 2 or more pads per day 66% 85%

Dr. Kella continues to document and monitor his patient outcomes for this and other surgeries to ensure he provides his patients with the best possible outcome.

Robotic prostate surgery with Dr. Kella, a video overview

Three Months after Robotic Prostate Surgery with Dr Kella

Robotic prostate recovery…video from a patient’s perspective

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Video on ProPep Nerve Monitoring with Dr. Kella

Click the video above to learn more about the Propep monitoring system

Dr. Joe Diaz

When Dr. Joe Diaz was diagnosed with prostate cancer, he did not waste any time researching different treatment options. After “doing his homework” on the subject, he decided to have Dr. Kella perform robotic surgery on him. Only six weeks after his surgery, Dr. Diaz was back to his active self and even summited Mt. Kilimanjaro –the highest peak in Africa

Robotic prostate surgery…video of actual surgery

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