Prostat Kanserinde Robotik Cerrahi
Prostat Kanserinde Robotik Cerrahi
Prostat erkeklerde mesanenin hemen altında, rektumun önünde yer alan salgıladığı sıvılarla spermin kayganlaşmasını sağlayan ceviz büyüklüğünde bir salgı bezidir. Bu salgı bezinde kanser hücrelerinin oluşmasına prostat kanseri denir. Kesin bir sebep olmamakla birlikte yaşlanma, ailesel prostat kanseri varlığı, hormonların etkisi, sigara ve obezite nedenler arasında sayılabilir.
Erken evrelerde herhangi bir belirti vermeyebilir. Evre ilerledikçe işeme problemleri, iktidarsızlık, kemik ağrıları, sperm de kan görülmesi, pelvik bölgede rahatsızlık, işemenin zayıflması belirtiler arasında yer almaktadır.
Prostat kanseri dünya ülkelerinin yaklaşık %60’ ında erkeklerde en sık tanı konulan kanserdir. Dünya çapında yaklaşık 1,4 milyon yeni vaka ve 375.000 ölümle prostat kanseri, erkekler arasında en sık görülen ikinci kanser ve kanserden ölümlerin beşinci önde gelen nedenidir.
Prostat kanseri tanısı parmakla rektal muayene, kan PSA düzeyleri ve prostat biyopsisiyle konulur. Parmakla rektal muayenede prostatda herhangi bir sertlik, nodül olması durumunda kanser şüphesi nedeniyle prostat biyopsisi yapmak gerekir. Parmakla rektal muayene normal bile olsa kan PSA düzeyinin yükseliğinde yine kanser şüphesi nedeniyle prostat biyopsisi yapılması gerekir. Birde son yıllarda multiparametrik prostat MR görüntüleme yapılmaktadır, MR sonucunda şüpheli lezyon varlığında , MR füzyon biyopsi dediğimiz yöntemle lezyonun olduğu alandan direk biyopsi ile daha kesin ve yüksek oranda kanser tanısı konulabilmektedir.
Robotik yöntemle prostat kanseri cerrahisinde; prostat ile birlikte meni kanallları, yüksek riskli hastalarda karın içerisindeki lenf nodlarıyla birlikte çıkartılmaktadır. Mesane ile üretra dediğimiz
Robotik cerrahide cerrah ameliyat bölgesini kendi gözünden çok daha büyük ve 3 boyutlu görebilmektedir. Bunun avantajları en küçük damarlar dahi görülüp kontrol altına alınması nedeniyle daha az kanama olması, idrar tutma ve cinsel fonksiyonlar üzerinde etkili olan mesane boynu , üretra ve prostat çevresinden geçen sinirler diğer yöntemlere göre daha iyi korunabilmektedir. Buda ameliyat sonrası idrar kaçırma ve cinsel fonksiyonlar üzerine robotik cerrahide üstünlük oluşturmaktadır. Robotla ameliyatta cerrahi alana karındaki küçük deliklerden girildiğinden ameliyat sonrası daha az ağrı, daha kısa hastanede kalış süresi ve hastanın normal hayatına daha erken dönmesini sağlamaktadır. Robotik cerrahi özellikle lokalize yani prostata sınırlı kanseri olan her hastaya uygulanabilir. Ancak ileri evre olup çevre organlara direk veya uzak organlara yayılım olan, anestezi alamayacak kadar genel durumu kötü hastalara uygulanamayabilir
Robotik cerrahi ile prostat kanseri operasyonundan sonra nadirende olsa idrar tutumada güçlük ve cinsel fonksiyonlarda bozulma görülebilmektedir. Ancak diğer cerrahi yöntemlere göre bu oran robotik cerrahide oldukça az görülmektedir. Robotik cerrahi sonrası hastalarımıza idrar tutma ve cinsel fonksiyonlar için yoğun rehabilitasyon programı, çeşitli ilaçlar ve penil protez (mutluluk çubuğu) uygulayarak bunların üstesinden gelebilmekteyiz.
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