Robotic Assisted Laparoscopic Prostatectomy FAQ

Patient Information Part 1

What is Robotic Prostatectomy?

 

Prostatectomy is the surgical removal of the prostate gland as a treatment for prostate cancer. To do this we now use a surgical robot called the ‘Da Vinci®’ and this enables us to do complex laparoscopic or “key hole” surgery, as opposed to the traditional open surgery.

The robot is controlled by the surgeon at all times and doesn’t work independently. The robot is connected to the patient and very small instruments are inserted through small surgical incisions in the abdominal wall. The surgeon sits at a separate console and does the operation without touching the patient. The surgeon has complete control of the robot at all times.

 1 Is the surgeon able to do the same operation with the robot?

Yes. In terms of cancer treatment it is regarded as the same as open surgery and doesn’t compromise cancer control.

 2 What are the advantages of robotic surgery?


This type of surgery offers many advantages for the surgeon and for the patient.
Surgical advantages

  • Highly magnified high definition view of operation
  • Complete 3D view
  • Much finer more delicate dissection
  • Far more precise surgery
  • Eliminates tremor


 3 Patient advantages

  • Lower complication rates
  • Lower infection rates
  • Less pain
  • Quicker recovery
  • Shorter hospital stay
  • Shorter catheter time
  • Less blood loss and a lower rate of needing a blood transfusion (1%)
  • Earlier return to work/normal daily activities
  • Improved cosmetic result

Comparisons between incision sites


 4 Are there any alternatives to this treatment?


Yes. These should have been discussed with you by your Urologist or Oncologist. Depending on your age, PSA, type of disease and other health issues, radiotherapy, brachytherapy, surveillance or hormone therapy are all treatment options. However this type of surgery is only chosen if we feel it’s the most appropriate treatment option for you, and you are happy to proceed.

 5 Are there any complications of this surgery?


Yes. All surgery has the potential for complications, however robotic surgery minimises these risks. These should be discussed with you by your surgeon before signing the consent form.

 6 Short term common risks (5-10%)

  • Bruising in the scrotum and penis and/or around the wounds – wear supportive underwear
  • More severe bruising across the abdomen, this happens rarely and resolves over the first couple of weeks. It doesn’t necessarily mean there is a problem with the operation.
  • Bladder spasms/pain with catheter
  • Constipation – this is important to avoid and you will be given medication for this
  • Blood in the urine
  • Urinary or wound infection
  • Facial swelling lasting a few hours
  • Shoulder pain lasting a few hours
  • Rectal discomfort or a desire to open the bowels which can last for the first hour or two after the operation
  • A feeling of abdominal bloating or gas inside the abdomen, this can last for a few days after discharge and settles once the bowels are open regularly


 7 Short Term Rare complications (Percentages are from my own audited data)

  • Bleeding requiring transfusion during or after the operation (2%)
  • Return to theatre for complications such as bleeding (0.5%)
  • Damage to structures around the prostate i.e. bowel/rectum/bladder/blood vessels or ureters (tubes between kidney and bladder)
  • Urine leak (0.5%), this is where urine leaks from the join between the bladder and waterpipe. It rarely needs reoperation and just heals up over a few days requiring a longer stay in hospital.
  • Risk of clots in the legs (DVT), or clots on the lungs(PE), again around 0.5%. You will have injections to reduce this problem. Keeping well hydrated and early mobilisation/walking helps prevent this problem.
  • Medical complications such as chest infections or heart attack, again this is rare and is less than (0.5%).
  • Conversion to an open operation – again this is rare (0%)
  • Readmission to hospital (4%)
  • Urinary retention after catheter removal (1.5%)


 8 Long term complications

Incontinence

Continence can be affected by this treatment however long term (longer than a year) incontinence that requires further surgical treatment is around 2-3%. The majority of patients will have some degree of incontinence when the catheter is removed and may need to use pads for a period of time. With robotic surgery continence recovers quicker. It is important to do your pelvic floor exercises before during and after your recovery. The physiotherapists will help in this area.

From my own audited results 29% of men will be pad free at 1 week after catheter removal, and at 6 weeks, 3, 6 and 12 months after the operation 47.2%, 72%, 84% and 92% of men will be pad free

Erectile dysfunction

Erections can be affected by this surgery, this is more likely in older age group and if you have weak erections before the surgery. In patients who want to keep their erections we can offer “nerve spare” surgery. This is part of the operation where we protect the nerves that go down to the penis, these run very close to the prostate and can be gently peeled off. We don’t offer this in patients with more advanced disease. Even with nerve spare surgery erections are not guaranteed. You will be given a daily tablet to help the erections recover, in some men this can take between 1 year to 18 months.

Urethral/Anastomotic strictures

This is scar tissue that forms in the waterpipe, patients may notice a slowing of urinary flow or struggling to pass urine, it can occur many months after the operation. Anastomotic strictures have occurred in 0.5% of men in my series. Sometimes it needs a minor operation to treat it.

 9 Will I lose my desire/libido after surgery?


No. The operation shouldn’t affect your libido.

It will however affect your fertility, you will have no ejaculate following the operation and in some men they notice a small degree of penile shortening.

 10 When can I start sexual relations?


There is no restriction on resuming sexual relations after the catheter is removed once you and your partner are happy to do so.

 11 Can the robot breakdown?


Potentially, although this is a very rare scenario, (less than 0.5%). If this happens either the operation can be rescheduled or the operation is done as an open operation. Over 2000 robots are being used worldwide and this has only been reported in a handful of cases.

 12 What happens from now?


Once we have decided on robotic surgery you will be

  • contacted with a date for the operation.
  • you will be asked to attend the pre-assessment clinic where routine bloods tests and an ECG, (heart tracing) are taken and an assessment of your fitness for surgery is made.
  • you will be invited to a ‘Patients Forum’, to discuss issues surrounding the surgery, ie continence, physio and erectile function
  • you will then be admitted to the hospital, on the morning of the operation, and meet the surgeon, anaesthetist and nursing staff.
  • you will be asked to sign the consent form.
  • you will have an enema administered before the operation, to ensure your bowels are clear .