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Frequently Asked Questions
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What is robotic surgery and how it is used to treat prostate cancer?
The surgery, also termed robot assisted radical prostatectomy and Da Vinci Prostatectomy, is performed by a surgeon utilizing the Da Vinci™ robot to enhance minimally invasive surgical techniques. The computer enhanced system comprises a 3 dimensional magnified view within a computer consule where the surgeon views the surgical field and performs the surgery in a simulated environment. The computer then translates the surgeons specific maneuvers to the surgical robot attached to laparoscopic ports placed into small keyhole incisions on the abdomen. This allows the surgeon complete control over the robot while performing the same open surgical maneuvers in a minimally invasive setting.
Who is a candidate for the surgery?
Any patient newly diagnosed with localized prostate cancer (click here to learn more about prostate cancertreatment options for early stage prostate cancer ).
What are the benefits of robotic radical prostatectomy versus traditional open retropubic radical prostate surgery?
The daVinci™ Surgical System allows our robotic-trained surgeon to perform precise surgical maneuvers in a highly magnified and 3-D view. This allows the surgeon to spare vital structures like the neurovascular bundles (responsible for erectile function) as well as spare the muscle responsible for continence while creating a watertight connection between the bladder and the urethra after removing the prostate. The results are a
- Shorter hospital stay
- Faster recovery and return to normal activities
- Less blood loss and minimal risk of transfusion
- Less pain
- Less scarring
- Faster return of urinary control (continence)
- Decreased scarring
- Less risk of infection
- Early removal of catheter
Does the robot perform the operation?
The Da Vinci™ robotic system is under complete control of the surgeon and is simply the surgeon’s tool. It cannot perform a surgical maneuver without the surgeon performing the same maneuver within the surgical console.
Do I need to donate blood prior to surgery?
No. One of the many advantages of robot assisted radical prostatectomy include minimal blood less and almost negligible risk of our patients requiring blood transfusion. Historically with the traditional open radical prostatectomy, patients typically donated blood preoperatively due to the relatively high risk of losing greater than 1000 cc during surgery. With the robotic approach, blood loss is typically between 100 and 300 cc’s, and the incidence of transfusion is less than 1% in experienced surgeons.
How long does a robotic radical prostatectomy typically take?
Our surgeons typically perform the robotic surgery in between 2 to 3 hours. Other operative time includes time to be induced and wake up from anesthesia, as well as proper patient positioning and surgical port placement. Variables which may alter surgical time include adhesions from previous surgeries or infections and the presence of unusual anatomy. Our surgeons aim to perform the surgery in an efficient manner, but the precision and quality of the surgery take top priority in order to give our patients the best possible outcome.
Is the entire prostate gland removed during surgery or only the part diagnosed with cancer on biopsy?
The entire prostate gland is removed during radical prostatectomy, along with the seminal vesicles which drain into and are connected to the gland. The prostate biopsy is effective in diagnosing cancer but sometimes underestimates the volume of cancer within the gland as well as even the aggressiveness of the disease. Removal of the entire gland helps provide the best opportunity to become cancer-free after the procedure.
How long do patients stay in the hospital after surgery?
Most patients are discharged within 36 hours after surgery.
When do patients resume normal activities after surgery?
Patients are encouraged to walk within the first few hours after surgery on the hospital ward. Usually patients can resume normal activities and office work within one to two weeks after surgery. Patients are typically advised to refrain from aggressive weight lifting and heavy exercise for about 4 weeks after surgery.
When will the patient learn of the pathology results of the prostate gland and lymph nodes after surgery?
The pathologists will review the aggressiveness of the cancer (Gleason Grade), the volume of cancer within the prostate, and if there is any extension of cancer outside of the prostate. This typically takes a few days and will be discussed with each patient at the time of their 1 week postoperative visit for catheter removal.
How much pain do patients typically have after surgery?
Most patients describe having achiness and a feeling of fullness after surgery instead of pain. Although all patients are given a prescription for narcotic medications upon discharge, most patients do not require them for pain relief.
How long does the urinary catheter remain in after surgery?
Typically the catheter is removed 1 week after surgery. The catheter allows for healing of the connection between the bladder and the urethra and allows drainage while the swelling goes down.
When can a person shower after surgery?
Patients can usually shower within 2 days after surgery.
Will I lose urinary control after prostate surgery?
With time, over 90% of men regain complete urinary continence after robotic prostate cancer surgery. The muscle responsible for urinary control is called the external urethral sphincter, which a circular band of muscle fibers that surrounds the urethra at the base of the penis. It is supplied by nerves which run in the area as well. After the prostate is removed, the urethra is reconnected with the bladder and the urinary sphincter regains normalcy as the area heals. Some men have control immediately after urinary catheter removal, but most will initially have some mild dribbling when coughing or straining (termed stress urinary incontinence). This improves during the initial healing process, during the first 3 to 6 months after surgery. Men will often wear small protective pads in their underwear during this time after surgery. At Comprehensive Urology, we have dedicated staff who specialize in pelvic floor muscle rehabilitation specifically designed to begin immediately after the catheter is removed in order to help regain excellent urinary control. Our team believes that excellent surgical technique is highly important to outcome. However, we also believe that postoperative rehabilitation therapy for urinary control and erectile function after surgery are equally as important for each patient.
Will I lose my erections after surgery?
While all men undergoing any form of therapy for prostate cancer have some risk of developing erectile dysfunction, at comprehensive urology for patients with early stage prostate cancer and good baseline erectile function, we preserve the nerves that help control erectile function. While erectile function usually deteriorates with time after radiation and other forms of treatments, erectile function usually improves with time after surgery. The Da Vinci robot allows a highly magnified view of the nerve bundles surrounding the prostate which are responsible for erections, thus making it easier to spare these fibers during surgery. The expertise of our surgeons allows them to preserve these nerves quite readily. Studies have shown that nerve sparing operations coupled with early penile rehabilitation will offer the best outcome for preservation of erectile function for our patients. We therefore start our patients on a penile rehabilitation program one week after completion of their surgery. With this approach, we have had outstanding results in preservation of our patients’ erectile and sexual function. Early data suggests possibly even better return to preoperative erectile function with robotic surgery, especially with younger patients. Recovery time typically is between 3 and 12 months.
General Information
Risk Factors for Prostate Cancer
Prostate Cancer Screening & Prostate Biopsy
Grading and Staging of Prostate Cancer
Treatment Options for Early Stage Prostate Cancer
Treatment Options for Advanced Stage Prostate Cancer
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