Robotic Assisted Laparoscopic Radical Prostatectomy

What is prostate cancer?

Prostate cancer is a malignant cancer that can increase to the lymph nodes, bones and other parts of the body. It is the most common reason of death in elderly men over 75 years of age.

What is robotic radical prostatectomy?

Robotic radical prostatectomy is a simply invasive approach to surgically remove the prostate gland. The prostate all along with the seminal vesicles are removed in total. The urethral stump is then sutured to the neck of the bladder to restore continuity of the urinary tract.

Traditionally the prostate gland was impassive with open surgery, where a large incision is made over the lower abdomen and this gives surgeon access to the prostate gland with instruments and hands. presently, keyhole surgery was developed to remove the prostate gland (laparoscopic radical prostatectomy) where the prostate gland was removed through several tiny incisions. This has been shown to decrease blood loss and allow rapid improvement from surgery, however keyhole surgery was technically challenging because the keyhole instruments are inflexible and only had limited range of movement.

Robotic surgery is similar to keyhole surgery, but robotic instruments are used instead of standard stiff keyhole instruments. The robot arms are thin instruments intended to replicate the surgeon’s hands, it contains many joints what allow greater accuracy increased range of motion and greater dexterity compared with standard laparoscopic instruments.The robotic instruments cannot do the surgery on its own. Instead, it translates the surgeon’s hand movements, at the control unit, into accurate movements of the miniature instruments atthe operation site inside the body. Robotic surgery also give the surgeon 3 dimensional vision which is greatly magnified to allow exact surgery.

How is robotic radical prostatectomy performed?

Robotic radical prostatectomy includes two machines, a control unit or the surgeon’s relieve and a patient unit. The surgeon sits at the control unit, away from the operating table, and controls the movement of four robotic arms of the patient unit present near the operating table. One of the robotic arms holds and positions a 3D high-definition camera through the incision in the operated area and provides images of the operation site to the surgeon at the control unit. These images are high resolution 3D images and are overstated 10 to 12 times. The other three robotic arms are used to hold small miniature surgical instruments that are introduced through the tiny (8 mm) incisions over your abdomen. defined removal of the cancerous tissue with a border of healthy tissue reduces the probability of repetition of the prostate cancer.

What are the advantages of robotic radical prostatectomy?

Robotic radical prostatectomy is a new higher laparoscopic approach that overcomes the boundaries of the traditional open as well as the laparoscopic approach. It provides the required tools for the surgeon to perform complex surgery through tiny incisions, with accuracy and ease, improving the outcome and reducing complications.

The miniature instruments used in robotic radical prostatectomy are more flexible and have a greater variety of movement compared to the long handled stiff instruments of the traditional laparoscopic surgery. The robotic arms minimize tremors that may happen from unintended shaking of the surgeon’s hands. The improved vision and superior control of the micro-instruments can help in the precise removal of the prostate without damaging the nerve fibers and the blood vessels near it, which are dangerous for the maintenance of bladder control and erectile function.

This technique provides a start of the art treatment approach for the management of prostate cancer to allow a fast recovery and control of sexual and urinary function in most patients. It also provides extra benefits of less blood loss, less pain, shorter hospital stay, faster return to normal routine activities and a lower incidence of complications.

What is nerve-sparing radical prostatectomy?

The neurovascular bundle that contains nerves that innervate the erectile apparatus of the penis runs around and in close proximity to the prostate gland. If the prostate cancer is localized within the prostate gland, the surgeon can quietly peel the nerves away from the prostate gland so they are not injured during prostate removal. Protecting these nerves mean there is a higher chance of recovery of sexual function, there may also be a quicker return to full continence.

What should I expect after the operation?

After the surgery you will get up with a urinary catheter tube placed in the bladder through the urethra. There will also be a drain tube from the abdomen to allow drainage of gas and fluid from the operation site.

You should be able to eat and drink normally and get up and walking the next day. The drain tube is also detached.

You will likely be discharged day 2 or day 3 after the operation depending on how comfortable you are. You will return home with the catheter in place. Most men require a urinary catheter for 10 days after surgery.

You will return to hospital day 7-10 after the operation for a dye test to verify the water pipe is fully healed on the inside before the catheter is removed. Please bring some continence pads with you to the hospital to use after the catheter is removed.

You’ll need to resume your action level gradually. You should be back to your normal schedule in about four to six weeks.

You won’t be capable to drive for approximately two weeks after going home. Don’t drive until your catheter is removed, you are no longer taking prescription pain medications and your doctor says it’s OK.

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