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Robotic radical prostatectomy is the most preferred way of treating localized prostate cancer.

Robotic prostatectomy is performed with the help of a Surgical Robot (da Vinci) through 4 to 5 small 1-cm keyhole incisions across the abdomen. Through these small incisions, the robotic arms enter the abdomen. The operating surgeon sitting at the operating console controls the robotic instruments to precisely dissect the prostate gland, seminal vesicles, and vasa deferentia from the urethra and bladder.

Once the prostate gland is dissected free from the bladder, rectum, and urethra, it is placed in a small plastic bag and eventually removed intact by extending one of the keyhole incisions. The complete prostate along with the lymph nodes are then
sent to the histopathologist for detailed examination. The bladder is sewn back to the urethra to restore continuity of the urinary tract using robotic instruments and absorbable suturing material. A Foley catheter is placed through the penis to drain the bladder and allow healing of the bladder-urethra connection. In addition, a small drain is placed around the surgical site, exiting one of the keyhole incisions.

Robotic surgery is performed adhering to the same anatomic principles of open surgery, but without the surgeon’s hands entering into the patient’s body cavity. Specially designed endowrist instruments allow seven degrees of motion that mimic the dexterity of the human hand and wrist. The result is a better anastomosis when the bladder and the urethra are sewn together after removal of the prostate. Thus the quality of open surgery is achieved without giving a big surgical incision and its associated complications. In fact, during robotic surgery, a high-resolution 3-D vision along with 10-12 folds magnification provides true-to-life view of the surgical field and gives the surgeon an excellent visualization and details of the prostate gland and the surrounding neurovascular structures, allowing for precise dissection of the prostate and suturing of blood vessels.

The average length of surgery is 2.5 – 3 hours but it varies from patient to patient (2.5 - 4,5 hours) depending on the size of the prostate gland, shape of the pelvis, weight of the patient, and presence of scarring or inflammation within the pelvis due to infection or prior abdominal/pelvic surgery.

Blood loss during robotic prostatectomy is routinely less than 300 cc. Transfusions are rarely required. Donation of blood prior to surgery for autologous blood transfusion can be arranged if the patient desires, but is not recommended.

Pain Another advantage of robotic surgery is much less pain compared to open surgery. Immediate post surgery pain medication can be controlled and delivered by the patient via an intravenous patient-controlled analgesia (PCA) pump or by injections by the nursing staff. Minor transient shoulder pain may be experience related to carbon dioxide gas used to inflate the abdomen during surgery.

Bladder spasms are experienced after prostatectomy as a cramping sensation in the lower abdomen. These spasms are transient and decrease over time. If severe, medication can be prescribed by your doctor to decrease such episodes.

Gas Cramps You may experience sluggish bowels and gas cramps for initial 2-3 days after surgery. Pain medications and effect of anesthetic drugs also prolong the recovery of bowel functions. Getting out of bed, walking, more fluids and stool softeners help in the recovery.

Hospital Stay Typically a patient stays for 1-2 nights in the hospital.

Back to normal activities One of several advantages of robotic surgery is earlier return to normal activity. Patient is expected to get out of bed and begin walking with the supervision and help of nurse on the evening of surgery. Gradually the physical activity is increased. Walking is strongly advised. In fact, prolonged sitting or lying in bed should be avoided to decrease the risk of forming blood clots in legs.

Driving should be avoided for 2 weeks after surgery. Most patients return to full activity at an average of 3-4 weeks after surgery.

Lifting heavy weights, strenuous exercises (jogging, biking, contact sports etc) should be deferred for six weeks or until instruction by doctor.

Diet & Bowel functions Oral liquids are allowed once you recover from the effect of anesthetic drugs. It is advised to take liquids and avoid high fiber diet in the beginning (till you have a normal bowel movement). It may take 2-3 days for the intestines to recover from the surgery and anesthesia. Pain medication, decreased physical activity and dehydration may cause constipation. Therefore, pain medication should be discontinued as soon as possible. Along with lots of fluids and mild laxatives or stool softeners may help in avoiding constipation. Once you have normal bowel movements, you may return to your normal diet.

Follow up Appointment

You will be discharged with a urinary catheter for draining the bladder and supporting the anastomosis (where the bladder and urethra is reconnected). The catheter is typically removed after 7-10 days following surgery.

Pathology results  The result of the examination of the radical prostatectomy specimen is usually available approximately 7 days following surgery. The results will be discussed with you in the office along with the implications of the findings on future treatment and follow up.

Need for further treatment The decision regarding the need for any additional treatment such as radiation or hormonal therapy is based upon the pathologic stage of the cancer found on radical prostatectomy specimen as well as the trend of PSA values following surgery.

Long-term follow up  First PSA test is drawn 6 weeks after surgery. Subsequently PSA is evaluated every 3 months.

Urinary incontinence  Most men will experience some degree of stress urinary incontinence (small urine leak with coughing and sneezing etc). This generally improves with time. Most men experience improvement within 3-6 months. Approximately 70% of the patients are dry at 6 months and more than 90% at 12 months. Pelvic floor muscle exercise (kegel exercise) may help in faster recovery of bladder control.

Avoid excessive caffeine, alcohol or fluid intake during the recovery period as this will exacerbate urinary leakage.

Erectile function  The return of erectile function following surgery depends upon age of patient, preoperative potency, nerve sparing surgery. Whether one or both side’s erectile nerve bundles can be spared depends upon the tumor volume, Gleason score and proximity of the tumor to prostate capsule. Discuss the issues related to return of erectile function with your doctor.

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