Robotic Radical Prostatectomy

What is a Radical Prostatectomy?

Radical means that the whole of the prostate is removed, rather than just a part of it, with the intention to cure prostate cancer. A prostatectomy is an operation to treat localised prostate cancer (cancer that has not spread outside the prostate gland). It is performed under general anaesthesia and involves removing the entire prostate gland, seminal vesicles (glands that p roduce semen) and possibly blood vessels, nerves and fat around the prostate. These are taken out to increase the likelihood of removing all the cancer cells. Once they have been removed, the urethra (tube that carries urine through the penis and out of the body) is then re-attached to the bladder. The pelvic lymph nodes ( small bean?ike structures in the lymphatic system where the cancer may spread to in high risk disease) are also removed.

A high magnification (x10) 3D camera allows the surgeon to see inside the abdomen. This is attached to one of the four arms on the robotic console and inserted into the abdomen through one of the keyholes. The other robotic arms can hold various instruments, which the surgeon will use to carry out the operation. The instruments are smaller (about 8mm) than those used for open surgery. Because of the robotic console and 3D camera, surgeon can carry out a precise operation in a smaller space, so a large incision is not needed.

The surgeon is in the same room, but away from the patient and he or she controls the robotic arms to perform the operation.

What is Robotic Surgery?

Robot assisted surgery is a technique that uses a robotic console (a control unit, the da Vinci?system) to help the surgeon during the operation.

Renal tumours are most commonly detected during health checkups or when one presents for some other ailment and investigations are performed. Hence the importance of periodic health check-ups cannot be stressed enough.It is important to understand that the robot is not performing the surgery. The surgeon still carries out the procedure, but the robotic console allows more controlled and precise movements during the operation.

Why Robotic Prostatectomy?

The advantages of RRP include:

• Shorter Hospital Stay
• Less Pain
• Less Risk of Infection
• Less Blood Loss reducing the need for a Blood Transfusion
• Less Scarring
• Faster Recovery
• Quicker Return to normal activities such as Driving.

Robot-assisted techniques give the surgeon:

• High Quality Vision
• 3-D view of the Operating Field
• Enhanced Dexterity
• Greater Precision
• Up to 10 Times Magnification.

Nerve Sparing in Robotic Radical Prostatectomy

The magnification and the dexterity provided by the robot, assists in excellent visualization and preservation of neurovascular bundles around the prostate. These neura l structures carry the signals to the corpora for erectile function. Hence, preservation of these structures helps in preservation and early recovery of erectile function as well as early recovery of urinary control.

What are the possible risks?

• Infection or hernia can occur at the wound site.
• Blood Loss: If the bleeding is severe, blood transfusion may be required. This occurs in less than 5% of men undergoing the robotic-assisted approach.
• Erectile dysfunction: Some degree of erectile dysfunction is likely after any form of radical prostate surgery; however, the preservation of the neurovascular bundles improves the likelihood of recovering erections.
• Urinary incontinence (inability to control when you pass urine): All forms of prostate surgery result in some degree of urinary incontinence in the short term. By retraining the bladder and performing pelvic floor exercises continence can be recovered within a few weeks or months for most patients.
• Injury to your rectum: Very rarely (< 1%) there can be injury to your rectum (last section of the bowel) and if extensive, may need a temporary colostomy.
• Neuropraxia: Rarely patients may experience areas of skin numbness due to their position on the operating table. This usually resolves by itself within a few hours or days.
• Problems relating to the general anaesthetic: These include chest infection; deep vein thrombosis (DVT); a pulmonary embolus (blood clot in the lung); stroke; or heart attack.

It is important to note that further treatment may be required, such as radiotherapy or hormonal therapy following surgery; if we find that the cancer has spread outside of the prostate. These findings are based on the final report from our pathologist.

Postoperative Course

• Oral intake allowed after 6 hours.
• Encouraged to walk and mobilize within 12 hours.
• Drain removal after 1 or 2 days.
• Discharge after 3 days.
• Review in OPD with histopathology report after 5 days.
• Catheter removal after 10 days.
• Resuming workouts and exercises after 30 days.