Robotic-assisted (Da Vinci®) laparoscopic radical prostatectomy: procedure-specific information

This article is intended to give detailed information about Robotic Prostate Surgery.

What exactly is the procedure? 

The prostate gland will be removed utilizing robotic-assisted procedures in this treatment.

What alternatives exist to this procedure? 

This will be determined by the specific form of cancer you have. Active monitoring (Active Surveillance) is sometimes necessary. Although open radical prostatectomy is an option, it is not currently offered in our hospitals. Other curative therapies include external beam radiation and brachytherapy. Other alternatives include hormone therapy (which is not curative) or a traditional laparoscopic (telescopic or minimally invasive) procedure. 

Recmed Medical has devised a novel procedure to remove the prostate gland (robotic-assisted laparoscopic prostatectomy). This article aims to tell you about what to expect from the operation, its benefits, and potential hazards. It will, hopefully, address the most frequently asked questions.

Concerning regular radical prostatectomy 

You will have discussed prostate cancer with your urologist and oncology nurse. Please keep in mind that early prostate cancer can be successfully treated. The majority of men with early prostate cancer will live for many years. A radical prostatectomy is a procedure that seeks to entirely remove the cancer and the prostate. The key advantage of surgery is that the cancer may be entirely eliminated. 

A radical prostatectomy is a procedure performed on individuals with prostate cancer to remove the prostate. The prostate, seminal vesicles, and surrounding tissues are removed to ensure that all malignancy is gone.

What is prostate and where is it? 

The prostate gland is a tiny, walnut-sized gland located at the base of your bladder. Its primary purpose is to add fluids to your ejaculate (semen).

What exactly is a conventional radical prostatectomy? 

This is a procedure to remove the prostate, however it is done through a 10-15 cm incision.

Occasionally, the surgeon will remove several lymph glands from the side of the prostate during the procedure. The surgeon will next remove your prostate as well as the two sacs behind it (seminal vesicles). The bladder is subsequently connected to the water channel (urethra) that runs down the penis, allowing regular urine passage. To allow the join to heal, a tube (catheter) is kept in place for 7-10 days. The procedure is quite safe and will be carried out by a professional and experienced surgeon. There are minor chances of general problems such as bleeding or infection, as with any procedure, but death is exceedingly rare (less than 2 in 1000).

The procedure is intended to remove both the prostate and the malignancy. On evaluation of the prostate by a pathologist following the surgery, it is sometimes discovered that the cancer has spread beyond the covering of the prostate gland. If this is the case, your urologist will discuss whether you require extra treatment, such as radiation, with you. This will also be determined by your PSA (prostate-specific antigen) level, which is checked at regular intervals in all patients. In the vast majority of men, your PSA will be near to 0 at all times, and you will not require any additional therapy.

What should I be prepared for before the procedure? 

Typically, you will be admitted on the day of your procedure. Preassessment is usually performed on the day of your clinic, or an appointment for preassessment will be established from clinic, to check your overall fitness, screen for MRSA carriage, and do certain baseline tests. We will give you the following medications to take the night before and the morning of the operation:

• Ranitidine (helps lower acid production by your stomach) 150mg should be taken at 10 p.m. the night before your surgery, and again at 6 a.m. the following morning (with a small amout of water). 
• (2) Glycerine suppositories to be taken the evening (8-9pm) before your surgery and when you get up (5-6am) on the day of your surgery to aid clear your bowels. Following your admission, you will be examined by members of the medical team, which may include the Consultant, junior Urology doctors, and your designated nurse.

You will be instructed not to eat for 6 hours before to operation. Our experts will offer you with elasticated stockings to wear in order to avoid thrombosis (clots) in your leg veins. 

The anaesthetic staff will visit you before to your treatment to confirm that they have no reservations about anaesthetizing you. At this point, you are invited to ask them questions about any worries or difficulties you have with the anesthesia.

Prior to surgery, you will need to undergo a tiny enema (Glycerine suppository). After your bowels have been opened, take a shower and change into a clean gown. 

Please notify your Urologist ahead of time if you have any of the following conditions: 

• an artificial heart valve 
• a coronary artery stent a pacemaker or defibrillator for the heart an artificial joint 
• a synthetic blood vascular transplant 
• a neurosurgical shunt or any other foreign body placed 
• a Warfarin, Aspirin, or Clopidogrel (Plavix®) prescription 
• A prior or present MRSA infection puts you at high risk of developing variant CJD (especially if you've had a corneal transplant, 
• a neurosurgical dural transplant, or previous injections of human-derived growth hormone).

What takes place throughout the procedure? 

A complete general anaesthesia is usually utilized, and you will be sleeping during the treatment. 

They may insert a drip into your arm or neck to gain access to your circulation during the procedure. You will be sedated and transferred to the operation room. You will be given antibiotics by injection during the procedure; if you have any allergies, please notify the anesthesiologist.

Robotic Prostatectomy with The Da Vinci® 

The Da Vinci® prostatectomy is a procedure that removes the prostate gland utilizing laparoscopic methods but with fewer incisions. In the operation room, a robotic console is put beside you. Three robotic arms are attached to the console, two for tools and one for a high-magnification 3-D camera that allows the surgeon to look within your belly. The two robotic arms may hold various devices linked to them and allow the physician to do your surgery. The breadth of the instruments is roughly 7mm. The devices have a higher range of motion than the human hand and, due to their size, allow the surgeon to do the procedure in a limited location within the body utilizing 3-D imaging.

Instruments are attached to the robotic arms via tiny port holes in your belly during robotic surgery. The operating surgeon sits in the same room, but distant from the patient, and uses robotic help to do more controlled and accurate motions. Of course, the procedure is not performed by the robot. The surgeon (who performs the procedure) controls the equipment, and the robot cannot function on its own.

What occurs right after the procedure? 

After your procedure, you will be brought to the recovery area. Even though you had minimally invasive surgery, you will experience discomfort, and pain relievers will be administered as needed. You will awaken with a catheter in your bladder, a wound drain from your belly (in certain situations), and six tiny incisions where the robotic port sites have been closed.

Clear fluids will be supplied to you to consume. It is critical that you notify the staff if you experience any discomfort or become nauseated while in the recovery room so that the right medicine may be administered. You will be transported back to the ward once the anaesthetic professionals, surgeons, and nursing staff have determined that your condition is stable. 

You must be ready to mobilize the day following surgery (and, in certain cases, the evening before).

Your catheter will be left in place for 7-10 days to allow the new anastomosis (joint) between your bladder and urethra to heal. In most cases, your abdominal drain will be removed the morning after surgery (if one was put in). The typical duration of stay for this treatment is 48 hours, with the vast majority of patients released after 24 hours. 

You will be discharged after you can move about securely, care for your catheter/leg bags, and your pain is well-controlled with suitable medicines taken orally.

Are there any negative effects? 

The majority of operations involve the potential for adverse effects. You should be comforted that, while all of these risks are well-known, the vast majority of people experience no difficulties following a urological operation.

What can I anticipate when I return home? 

Before you leave the hospital, the staff will make sure you are healthy enough to go home. Dalteparin is a medication that helps maintain your blood thin in order to prevent clot formation. We also advise you to use the elasticated (TED) stockings for 4 weeks after discharge. You will be issued a discharge report of your admission when you leave the hospital. This contains vital information concerning your hospital stay and surgery. Please bring this summary with you so that the physicians may review the specifics of your therapy.

You may need some comfortable, loose clothing when you are discharged from the ward since your abdomen may be unpleasant and bloated.  

You will need someone to stay with you at home for the first few days following being released. After laparoscopic surgery, a 2-4 week recovery period is normally required. It is common to feel weak and weary during this period.

How much discomfort will I feel? 

Most patients have far less discomfort than with open surgery since the operation is conducted through a tiny incision. Patients require less pain medication, and after one week, very few men have any discomfort after all.

When am I allowed to exercise? 

Following the operation, light walking is suggested. Jogging and aerobic activity are permitted after two weeks. You can resume light lifting after four weeks.

Can I take a shower or a bath? 

Yes. Your abdominal sutures are dissolvable, and the adhesive or dressings are waterproof. We recommend that you properly rinse any soap from your body as this may aggravate the wounds. To reduce the chance of infection, carefully pat yourself dry. 

When am I allowed to drive? 

When you are comfortable (typically two weeks after surgery) and feel able to make an emergency stop. Please contact your insurance carrier before driving again.

When will I be able to resume sexual activity? 

This will be determined by whether or not a nerve-sparing treatment was available at the time of surgery. We suggest that you take careful note of any erections or sensations you experience and mention them to the consultation staff during your follow-up meetings. Almost many men will lose all erection function in the first several months following surgery while the nerves heal (if nerve sparing has been possible).

If you have had a nerve-sparing treatment, we will usually put you on medication such as Viagra or Cialis when you return for your findings 6 weeks after surgery. We recommend that you take this exactly as directed in order to enhance blood flow into the penis and aid with erection restoration. We would not anticipate this to result in erections right away, and some patients may take up to two years to regain any natural erectile function. Furthermore, vacuum devices can be employed alone or in conjunction with the foregoing. If oral medicine fails, we can arrange for you to be seen by an erectile dysfunction specialist nurse to explore additional options.

When can I go back to work? 

Please give yourself a couple of weeks off before returning to work. If your job requires heavy lifting, please contact with your doctor before leaving the hospital.

By RECMED MEDICAL - UROLOGY DOCTORS