Frequently asked Questions about the Robotic Prostate Surgical Procedure

What is robotic surgery?

Robotic radical prostate surgery employs techniques of laparoscopy to place surgical ports into the abdomen and perform surgery under computer assistance of a surgical robot attached to the laparoscopic ports. Attributes of the robotic system are:

  1. Three-dimensional magnified vision
  2. Articulating, endo-wrist technology
  3. Intuitive movements with scaling

For more information on the robotic system, please visit the Intutive Surgical Incorporated website at www.davincisurgery.com.

What are the benefits of robotic radical prostatectomy versus traditional open retropubic radical prostate surgery?

Any patient newly diagnosed with localized prostate cancer, may be a candidate for robotic radical prostate surgery. Attributes of the daVinci™ Surgical System (Intuitive Surgical Incorporated, Sunnyvale, CA) allows your robotic-trained surgeon to visualize complex and vital structures in the pelvis. This allows for a more precise and less invasive surgical procedure which spares crucial structures in order to offer patients a greater chance at functional recovery after surgery.

Numerous published articles in peer-reviewed medical literature (see bibliography) has shown that robotic prostatectomy offers the following potential benefits over traditional open retropubic radical prostate surgery:

  • Shorter recovery time with patients walking 6 hours after surgery
  • One day hospital stay for a majority of patients
  • Decreased pain
  • Decreased blood loss with <0.05% of patients requiring transfusions
  • Less scarring
  • Better chance of functional recovery (continence and potency)

Who actually performs the operation, the surgeon or the robot?

The robotic system is simply a tool and does not have the capability to perform the operation without the surgeon. The surgeon uses the robotic instrument much as he/she would with a scalpel. It is for this reason that patients should ask their surgeon of his experience performing the operation. Surgeons performing large volume and those with fellowship training are more likely report better outcomes.

Does the entire prostate gland have to be removed or just the part(s) with the cancer?

By definition, radical prostatectomy requires that the entire prostate gland with the seminal vesicles be removed entirely. The diagnosis of cancer is based on the biopsy which often underestimates the aggressiveness of the cancer or the volume of cancer in the diseased prostate. Entire removal best assures the possibility of cancer-free survival after surgery.

Should the lymph nodes also be removed during robotic prostate surgery?

Basically yes. However, many Urologic surgeons will not remove the lymph nodes for patients with extremely focal and early disease. This decision should be made between you and your trained robotic-surgeon.

How long does a robotic radical prostatectomy typically take?

The actual procedure normally takes 1 ½ to 2 hours for experienced robotic surgeons. Depending on the anatomy, presence of adhesions (scar tissue) and other factors, the operation could take up to 1 hour longer.

Is robotic radical prostate surgery performed under general anesthesia?

Yes, patients are placed under general anesthesi

What is my risk of transfusion and will I need to donate blood prior to surgery in case of a transfusion during or after surgery?

Blood loss is typically 100 – 200 cc’s during robotic radical prostate surgery. The incidence of transfusion is less than 1% in experienced surgeons. Therefore, we counsel patients not to donate blood.

Tell me about urinary control after this procedure?

The external urethral sphincter is an innervated (nerves) circular band of muscular tissues that surrounds the urethra at the base of the penis. This sphincter is responsible for maintaining continence in men after surgery. This mechanism takes time to function completely and keep men continent. A majority of men will be continent, but will experience stress urinary dribbling after surgery. This improves over 3- 6 months after surgery. During this time, men will often wear small pads in their underwear.

Tell me about erectile function after prostatectomy?

All patients undergoing radical prostatectomy, regardless of the type of surgery used (open vs. laparoscopic vs. robotic), will experience problems achieving and maintaining an erection. Sensation and libido are not affected by the surgery. Based on your preoperative erectile function, robotic surgery offers men an earlier time for erectile function recovery given the minimally invasive approach to removal of the prostate. The time for recovery typically takes between 3 and 12 months after surgery. Given the fact that the seminal vesicles and vas deferentia are removed, there is no emission during sexual relations after prostatectomy.

How long do patients typically stay in the hospital after surgery?

Most patients (97%) are discharged within 24 hours after surgery.

How soon can I resume normal activities?

This is a decision based on each individual undergoing surgery. Typically patients are able to resume normal activities within 7 - 10 days after surgery. This correlates to the same time your urinary catheter is removed. All patients are asked to walk 6 hours after surgery with the assistance of a family member or nurse on the ward.

What are my limitations or restrictions after surgery?

Patients are asked to walk daily and may traverse stairs or steps in their home. Avoid lifting over 15 lbs. Also patients are asked to avoid any heavy lifting, exerting or excessive physical activity.

Will I have pain after the operation?

Most patients describe having discomfort as opposed to pain. Intravenous narcotics are not given, but patients are given oral pain medications for relief. Many patients do experience abdominal bloating which is also called an Ileus. Patients are required to maintain a clear liquid diet after surgery until their bowel function returns, which could be up to 3 days after surgery.

How long do I keep my urinary catheter after the surgery?

The urinary catheter, or foley catheter, is required to allow for healing of the connection between the bladder and the urethra. In addition, the catheter allows for adequate drainage of the urinary bladder. The catheter remains in place for approximately 7 – 10 days after surgery.

When can I resume driving?

When your catheter is removed AND when you are no longer using pain pills.

When can I shower after the surgery?

Patients are allowed to shower on the second day after surgery. Most patients are home by this time. Tub baths and hot tubs are not allowed.

Can the robotic equipment malfunction during the surgery and if so, what happens then?

The robotic surgical system is meticulously maintained by the hospital and a company service representative. The robotic system has never malfunctioned at Saint Joseph’s. However, if the robotic system mechanically fails during surgery, the procedure would be completed laparoscopically or by converting to an open surgical technique.

I am from out-of-town, are there any special arrangements that are made for patients that are not from Atlanta?

Yes. Currently, the hospital has developed a hospitality program with local hotels near the hospital. Please ask about the program when you contact Saint Joseph’s for more information on robotic radical prostate cancer surgery.

 

For more information about robotic surgery, call 1-866-SJ-ROBOT (1-866-757-6268).

To make an appointment, call
404-778-4898