MUSC urologist offers single-port surgery for prostate operations

Azmi Jebali and his wife Beth run a farm-to-table restaurant in Lexington, South Carolina, called Mediterranean Cafe. It’s a hands-on operation. “So we have a small farm, and I'm the farmer too,” Azmi said.

It’s a busy life, one that requires long hours and a lot of the couple’s attention. So when Azmi was diagnosed with cancer, it was an unwelcome diversion.“When I went to my doctor here in town, he told me it's an aggressive type of prostate cancer. I started freaking out,” Azmi said.

Once he had time to absorb the news, he and his wife started researching the best way for him to get treatment. “Initially, when Azmi was diagnosed with prostate cancer, we knew he couldn’t have his prostate taken out the normal way through the abdomen,” Beth said.

“I have a preexisting condition in my tummy and intestines. Nobody recommends having the surgery through my stomach,” Azmi said.

 

But they knew there had to be another option. Their search led them to Jay Chavali, M.D., a urologist at MUSC Health who was offering what’s called single-port prostate surgery through the bladder. 

“Single-port robot-assisted surgery involves only one incision, typically about three to four centimeters long, through which the surgeon inserts all the surgical instruments and a tiny camera, which transmits pictures to a screen where the surgeon views the patient’s anatomy while performing the procedure,” Chavali said.

“This approach makes surgery possible within a small tunnel with minimal disruption of surrounding areas and does not require multiple incisions like a traditional robotic surgery.”

The surgeon can take one of two approaches in single-port surgery for the prostate and other urologic areas:

• Extraperitoneal, which involves an incision just below the navel that avoids disrupting the peritoneum, the cavity that includes the stomach, liver and intestines.
• Transvesical, which involves going through the bladder.

The transvesical option was a good fit for Azmi Jebali, Chavali said. “Prostate surgery patients who undergo single-port robotic surgery often experience faster recovery and have better early outcomes than patients who undergo open surgery or other traditional minimally invasive surgical approaches.”

 

Chavali said patients lie flat during the procedure instead of with the head tilted down, which is the traditional position for prostate surgery. Lying flat prevents side effects from having the lungs and heart tilted down for four hours.

And the single-incision procedure has other benefits, he said. “The patient doesn’t need any narcotics. They just go with Tylenol and ibuprofen. And because it's done through a different space, they have less of the discomfort from the bowel aspect because we are not messing with the bowel as we would with traditional surgery.”

The Jebalis were pleased with the results and happy to be able to give the restaurant their full focus again. “Recovery is very short. Dr. Chavali knows what he's doing,” Azmi said. “Basically, when he took the prostate, he took all of the cancer. I'm very happy with what he did. So we’ve already recommended him to a couple of people.”

Chavali, the only doctor in South Carolina using this method for prostate removal, also does other single-port kidney and prostate surgeries. “Most patients with heart or lung disease or who have had previous abdominal surgeries have limited surgical options. They need to find the right specialist,” Chavali said.

“This kind of operation requires a highly skilled surgeon who has advanced training in single-port robotic surgery. There’s a definite learning curve. The single-arm robotic platform remains cutting-edge and is currently being used in only a few centers in the country. I encourage patients to have a candid conversation with their surgeon about the feasibility of single-arm robotic surgery.”