What is Robot Assisted Laparoscopic Radical Prostatectomy?
Your doctor has recommended a procedure, Robot Assisted Laparoscopic Radical Prostatectomy to treat your prostate cancer.
Before we talk about the procedure, let’s review some information about the prostate and your medical condition.
The prostate is located under the bladder and behind the penis.
It is a walnut-sized gland that is part of the male reproductive system. It helps make semen.
The Urethra is a tube that carries both urine and semen to the penis. It passes through the prostate which surrounds it like a donut.
Prostate cancer is the second most common cancer in men. It usually occurs in men age 50 and older and those men that have a family history, especially a father or brother with prostate cancer. But the highest risk is for men that are African American and over age 70
The treatment of your cancer will depend on many factors including the size, spread, and type of cancer, your age, and health.
The options that you may have considered are “watch and wait”, medication including hormones, radiation therapy, and/or surgery.
It is very important that you understand why this surgery has been recommended for you. If you have questions, ask.
Radical Prostatectomy is surgery to remove the whole prostate gland, some nearby tissue, and lymph nodes. Everything removed is tested to be sure cancer has not spread.
This surgery is only used as a treatment if prostate cancer is still in the prostate. If cancer has already spread, then surgery does not help and can cause serious problems when other treatments are used.
In fact, if during surgery, the surgeon finds that cancer has already spread and is outside of the prostate, the procedure is stopped and other more effective treatments for the situation are planned.
There are different ways to operate and remove a cancerous prostate.
Your surgeon has recommended a laparoscopic procedure.
A long instrument with a light and camera called a laparoscope is used. The scope makes it possible for your surgeon to see and operate on hard to reach, delicate tissue.
This is a minimally invasive surgery that uses very small incisions instead of a classic large incision. Healing and return to normal activity is usually faster with less bleeding and fewer complications.
With all laparoscopic procedures, the surgical team is prepared to change your surgery to an open procedure with a larger incision if this becomes necessary. An open procedure is sometimes needed to treat unexpected bleeding or other findings during a procedure that make it impossible to do using a laparoscope. If this happens your stay in the hospital and recovery will be longer than you originally expected.
Your surgeon has scheduled your laparoscopic procedure to be Robot Assisted.
This means that your surgical team will work with pieces of equipment that together are called the robot.
The tower has a video screen for the team and surgeon to see the surgery in high definition.
The surgeon sits at a console that makes it easier to see drive and move special tools to do delicate cutting and stitching.
The robot has arms that attach to the laparoscope and other tools as needed.
Now let’s talk a little more about what happens during a Robot Assisted Laparoscopic Radical Prostatectomy.
General anesthesia and medications to make you asleep and pain-free during your procedure are given.
A tiny incision is made and your abdomen is filled with CO2, carbon dioxide gas.
Other small incisions are made as needed for the surgeon to place tools that are used to cut, stitch, move and remove tissue for the procedure. The robot is carefully connected to the laparoscopic instruments.
The bladder is gently separated from the prostate,
The connection of the prostate to the bladder is cut.
And then the connection to the urethra,
The surgeon is careful to protect the nerves that control your erection and urination.
However, Damage to the nerves may be necessary or unavoidable in removing your prostate.
The Prostate is carefully placed in a bag and removed thru a small incision. This way no cancer cells are spread.
Finally, the bladder is stitched back to the urethra
The surgical area is carefully inspected for bleeding and a surgical drain is placed.
The instruments and gas are removed. The incisions are closed.
After surgery, “speak up” and tell someone on your care team if you have unexpected pain, dizziness or trouble breathing. You will have some discomfort but medication should help if you have pain.
Your risk of complication from this surgery is most related to your health before surgery, the size, and nature of your cancer, and the experience of your surgeon.
Prostate cancer typically affects older men with other medical problems. Your team will watch for early rare complications such as stroke, heart attack, blood clot, and internal bleeding.
Most patients stay in the hospital for 1-3 nights after surgery. The drain is often removed before you are sent home.
The Foley will stay in place for about 1 to 3 weeks. Incontinence, leaking urine is a known side effect of prostatectomy. It is normal to have after your Foley is removed. You will need to wear a pad to stay dry. Control of urine improves quickly over the following days, weeks, and months.
By 6 months, 20% or 1 in 5 men still have some urine leakage and 5% or 5 in 100 men have severe leakage.
Another side effect of this surgery is erectile dysfunction or ED. All men will have trouble with their erections after prostate removal. Half of men, 50% will eventually be able to have an erection but most will continue to have some permanent changes. Time, exercise, medication, and surgery can help.
Call your doctor if you: cannot urinate, have a fever, redness or pus from your incision, worsening pain, or bright red bleeding that doesn’t stop
Be patient as you heal. Communicate your concerns with your surgeon. If you do have long term side effects from your procedure, you can see improvement with time, further healing, medication, exercise, or more surgery.
To avoid cancellation or complications from anesthesia or your procedure, your Job as the Patient is to-
- Not eat or drink anything after midnight, the night before surgery, not even a stick of gum
- Take only medications you were told to on the morning of surgery with a sip of water
- Ask when to stop your aspirin or blood thinners before surgery
- Arrive on timE
You should be ready to verify or confirm your:
- list of medical problems and surgeries,
- all of your medications, including vitamins and supplements
- current smoking, alcohol, and drug use
- all allergies, especially to medications, latex, and tape
But, not all surgeons find using the robot helpful in performing laparoscopic surgery.
Not all hospitals have this equipment. The robot adds about 30 minutes to your procedure for set-up, it is more expensive and there have been rare but serious complications related to its use. Your surgeon has recommended the robot for your situation and believes it may help there to be less bleeding, nerve damage, incontinence, and/or erectile dysfunction.
