What should patients expect before, during, and after a robotic prostatectomy surgery? Like the traditional open prostate cancer removal procedure, minimally invasive robotic prostatectomy surgeons will excise the prostate, lymph nodes, and surrounding cancerous tissue, but instead of accessing the surgical field through a single, large incision, the surgeon will approach the prostate through a series of small incisions made in the abdomen. This minimally invasive technique reduces the risk of blood loss, shortens the needed hospital stay, and decreases the pain and length of patient recovery. In general, a robotic-assisted laparoscopic prostatectomy, such as the da Vinci® robotic surgical system, takes approximately two to four hours to complete with an anticipated hospital stay averaging one to one and a half days.
In preparation for prostate cancer robotic surgery, the surgeon will provide the patient with a set of instructions for bowel preparation to be performed the day before the scheduled event. On the day of procedure, the patient will receive anesthesia and be positioned in a supine, Trendelenburg position, meaning face up with the body angled so that the pelvis is positioned above the head. The abdomen will then be inflated with carbon dioxide gas to create a space for the surgeon to operate. Next, the patient-side surgical team will make a series of five to six incisions across the abdomen. Within these incisions, the operating team will place ports through which an endoscope and robotic arms will enter the body and perform surgical tasks.
Surgical Steps of a Laparoscopic Robotic Prostatectomy
After the patient is prepped for a robotic prostate removal procedure, the surgeon will control a patient-side cart containing robotic arms and wristed instrumentation through the use of a console equipped with a three-dimensional image system and two hand controls. A scrubbed operating team assists the surgeon throughout the procedure by keeping the operating site clean via suction. Robotic laprascopic prostatectomy devices, like the da Vinci® prostatectomy system, feature three to four robotic arms of which one holds a powerful endoscope that transmits real-time imagery of the operating site to the surgeon-controlled console. The other two to three arms contain a series of micro-instruments that mimic the surgeon’s precise movements to perform a number of tasks including, but not limited to, suturing, clamping, and dissection.
Using the hand controls of the console, the surgeon guides the movement of the robotic arms by first dissecting the membrane lining the walls of the abdominal cavity, known as the peritoneum. To limit bleeding, the prostatic veins are stitched and the prostatic arteries controlled using sutures, clamps, or bipolar forceps. The surgeon will then disconnect the prostate from the bladder. If the cancer is confined within the gland, the surgeon will perform a variation of prostate removal known as a nerve-sparing robotic prostatectomy. Here the surgeon precisely dissects the neurovascular nerve bundles responsible for sexual function from the prostate, leaving them in the body to preserve the patient’s ability to have and hold an erection. Nerve-sparing is a delicate procedure requiring the skill of an experienced surgeon. The magnification of the operating site (made possible by the endoscope) as well as the micro-instrumentation of the robotic arms, are both features of robotic surgical systems that are well-suited to this type of surgery and when operated by an experienced individual, typically yields positive nerve-sparing results. The surgeon will then remove the surrounding lymph nodes and connect the bladder to the urethra to maintain patient continuity. During this step of the procedure, surgeons will often attempt to minimize damage to the muscles surrounding the urethra for the fast return of post-operative urinary control. The cancerous gland is then removed through the umbilical port and all incisions closed.
Recovery after Robotic Prostate Removal
Patients are encouraged to move the evening of the surgery and are typically discharged the day of or the day after the procedure. Catheters are generally removed 4-7 days after the surgery and patients can expect to return to work and continue with everyday activities a week to two-weeks after the robotic-assisted laparoscopic prostatectomy. Patients should avoid strenuous activity and heavy lifting for a period up to 4-weeks. Due to the minimally invasive nature of the procedure, pain is less severe than open prostate cancer surgeries and can be controlled via minimal pharmacologic intervention. Patients can expect a period of incontinence, but typically will regain complete or partial urinary control within a month’s time. Return of sexual function is dependent upon the surgeon’s ability to preserve the neurovascular nerves during the robotic prostatectomy. If the cancer was confined to the prostate gland, and thus, nerve-sparing possible, clinical results reveal a return of sexual function within a period of one to three years. Results vary on many factors, including the patient’s emotional state, age, sexual desire, and the surgeon’s nerve-sparing success. During this period of erectile dysfunction, there are a number of assistive actions, like erectile dysfunction medication, that can be explored to achieve sexual intercourse.