What is Robotic Prostatectomy?

WHAT IS A ROBOTIC PROSTATECTOMY?

A robotically assisted laparoscopic radical prostatectomy utilizes the da VinciSurgical System. The da VinciSystem is a computer enhanced, minimally invasive surgical tool controlled by the surgeon.
The patient side cart sits at the bedside and holds the 4 robotic arms. The console is an ergonomically designed device that allows the surgeon’s movements to be translated into action utilizing the robotic arms. The robotic arms utilize EndoWrist instruments that have more degrees of freedom and precision than the human wrist.
The da VinciSurgical System is the first operative surgical robot approved for surgical use by the Food and Drug Administration.

HOW IS ROBOTIC PROSTATECTOMY PERFORMED?

A robotic prostatectomy is performed through small laparoscopic ports. Typically, five ½ to 1 inch keyhole incisions are made in the abdomen for introduction of the laparoscopic ports. The traditional surgical approach uses a larger incision from just below the umbilicus to the pubic bone. The abdomen is inflated with carbon dioxide gas to create a surgical working space. The surgeon operating the robot controls the camera and 3 separate mechanical arms inserted through the laparoscopic ports. The surgeon at the bedside works through the 5th port providing exposure and introducing and removing suture and surgical clips.
The surgical team then removes the lymph nodes and the prostate and reconstructs the urinary tract in a manner similar to the traditional open approach.

WHY PERFORM THE ROBOTIC PROSTATECTOMY?

The traditional open prostatectomy was associated with significant morbidity in years past. High volumes of blood loss, significant pain for the patient, long hospital stays, high rates of urinary incontinence (urine leakage) and high rates of erectile dysfunction used to be the norm. Advances in surgical technique and a better understanding of anatomy have decreased these risks into a more acceptable range.
The robotic prostatectomy may be the most important technologic advance in the surgical treatment of prostate cancer. The advantages of the robotic system combined with proven surgical techniques aim to achieve even better patient results.

HOW CAN THE ROBOTIC PROSTATECTOMY IMPROVE THESE RESULTS?

The da VinciSurgical System offers improved visualization, magnification and surgical precision over open surgery. The specially designed InSiteVision System offers magnification and a 3-D visualization of vital anatomy such as blood vessels and nerves. The mechanical arms provide precision and freedom of wrist movement greater than that achieved by traditional laparoscopic instruments and even the human hand. They also act to reduce the fatigue associated with long procedures and eliminate tremor.
These advances should allow the surgeon to separate critical nerves, blood vessels and muscles from the prostate to improve the side effects of erectile dysfunction and incontinence while reducing blood loss and still completely removing the cancer. The smaller incisions may reduce post-operative pain, reduce scarring, shorten the hospital stay and lead to faster recovery and return to normal activity.

WHAT CAN I EXPECT AFTER SURGERY?

Patients can expect a 2 or 3 night hospital stay in single-patient hospital rooms where a family member may also stay. A post-operative pathway ensures safe and efficient patient care. Both written and verbal post-operative instructions are provided prior to discharge.
Patients can typically expect their catheter to remain in for 10 – 14 days after surgery at which point they will return for removal and a discussion of their pathology report.

The Operation: Laparoscopic nephrectomy / Robotic Nephrectomy is a Key hole surgery performed through 3-5 small incision on the abdomen through which various instruments and telescope is inserted after distending abdomen by a gas. The kidney is dissected all around the vessels and the ureter is clipped. The final specimen is retrieved after inserting in a plastic bag either extending a port or putting a separate incision (Pfannensteil)

Open ProcedureLaparoscopic Procedure

Although this procedure have stood test of the time , but like any other surgical procedure it also carries some risk of complication.

The usual blood loss is less than 100 cc and need for blood transfusion is seen in less than 5% of patients.

Infection:All the patient are give preop / intra op antibiotics and usually is continued 24-48 hours post surgery. The risk of the infection is less compared to open surgery, however it may happen.

Tissue / Organ Injury:Although the risk is small if done in experienced hand but in large tumor or a inflamed kidney there can be injury to the surrounding organs or vasculature requiring open conversion or other intervention.

Hernia :Hernias are quite rare because of the smaller size of incision , but may occur.

Conversion to Open Surgery :Conversion to open surgery is not the failure of the surgeon to do a key hole surgery but is a wise decision for the safety and better outcome of the patient. It may be needed if there is failure to progress because of dense adhesion to surrounding structure, or bleeding or injury to surrounding viscera.

During your hospitalization.

Patient is shifted to the recovery room after surgery, where he is kept for observation for 4-6 hours. If vitals and other parameters are normal, he is usually shifted to his room post surgery on the same day unless any other comorbities exist requiring ICU care.

• Postoperative Pain :There may be a transient pain in the shoulder which is due to the carbon dioxide insufflation. Wound is usually infiltrated with local anesthesia during surgery and post operatively patients receive adjuvant Intravenous analgesics in consultation with the anesthetist.
• Nausea : It may happen because of the medications or the anesthetic drugs.
• Urinary Catheter :Urinary pipe may be present for couple of days to monitor the urine output. It is usually removed by second postoperative day.
• Diet :Most of the patient are give clear liquids by evening and a normal diet next day once he starts tolerating the liquids well.
• Fatigue :Generalized weakness and fatigability can be there because of the anesthetist or other drugs. Usually subsides in 5-7 days.
• Incentive Spirometry : As many patient hold there breathing because of the pain which can result in some lung related complication. Incentive spirometery is advisable to expand the lung and prevent post
• Ambulation :Patient is ambulated on the eve of the surgery. Early mobilization reduces the risk of of blood clots in the leg veins , it also speed up the recovery and bowel movement.
• Hospital Stay :The usual hospital stay is 2-3 days in Laparoscopic / Robotic Nephrectomy
• Constipation / Gas Cramps :Patient can have mild abdominal distention and constipation due to the anesthetic drugs and other medications specially analgesics. Patient are usually given laxative and early mobilization helps in reducing the bowel discomfort.
• Pain Control :There may be mild incisional discomfort, and usual oral analgesics are sufficient to care of that.
• Showering :Patient can take shower 3 days post surgery, they can wet the surgical site but have to pad it dry immediately after taking the bath.
• Activity :Patient starts walking on the eve of surgery. He can climb stairs after a day. Patient should avoid exercise and gyming for 4-6 weeks. Usually they can resume there normal office work 2-3 weeks after the surgery.
• Diet :it is advisable to take low salt , low protein diet post kidney removal. Dietician and nephrologist should be consulted for the proper dietary advice.
• Pathology Results :The pathology report is usually available after 5-7 days of the surgery. Patient needs to review with the surgeon again with the histopathology report.
• Kidney/Liver Function Blood Tests and Xrays :Patients need to on regular follow up as advised by the surgeon.