Robotic-Assisted Prostate Surgery
Among many options for surgical removal of the prostate gland is the da Vinci® robotic surgical system, an innovative, minimally invasive procedure for prostate removal. Urologists who perform robotic-assisted surgery are specially trained in this precise technique.
Robotic surgery is the latest advance in surgery to remove the prostate. Similar to open surgical approaches, robotic surgery removes the entire prostate through a series of small incisions.
The system’s magnification and 3-D visualization work together to enhance the surgeon’s viewing of the prostate, nerves, bladder and surrounding structures. It offers the surgeon the same dexterity as the human hand by “translating” the surgeon’s hand movements into the precise movements of the robot’s micro-instruments. This allows the surgeon to remove the prostate and nearby areas of concern, while sparing structures that may negatively impact urinary control and sexual function.
Benefits of Robotic-Assisted Surgery
The small incisions, resulting in a shorter post-operative recovery, are the main benefit of the robot. In addition, robotic surgery results in the following benefits:
- Less blood loss
- Shorter hospital stay and faster return to normal activities
- Maximum outcomes for urinary control and sexual function
- Smaller incisions and less scarring
- Oncologic results (removing the entire prostate for cancer staging)
Prostatectomy (Prostate Gland Removal)
During the robotic procedure, a patient is placed under general anesthesia and positioned on his back. The surgeon makes six small incisions — from ¼-inch to ½-inch long — in the patient’s abdomen.
Hollow cylinders called ports are placed in the incisions, and an operating telescope, camera and surgical instruments are inserted through the ports and into the abdomen. The robot is then positioned at the operating table, and the robotic arms and camera are connected to some of the ports. The surgeon sits at the console a few feet away from the patient, controlling the robotic arms and camera. The surgeon views the surgical area through 3-D goggles, which provide fine details of the body structures.
Once the prostate has been detached from surrounding structures and the urethra (urine tube) has been reattached to the bladder, the robotic arms are removed from the patient. The incision near the navel is enlarged so the entire prostate gland can be removed at once. This is important so the pathologist can accurately determine the stage of the cancer. All of the instruments are removed, and a temporary urinary catheter and abdominal drain are left in place before the patient is awakened from anesthesia.
Risks of the Procedure
While all precautions are taken to minimize surgical risks, all procedures have risks. Risks associated with robotic-assisted prostatectomy include bleeding requiring blood transfusion, infection, urinary incontinence, erectile dysfunction, port-site hernia and injury to adjacent organs.
What to Expect After Surgery
After surgery, patients usually spend one or two days in the hospital. During the first day, the patient recovers from the anesthetic and receives intravenous (IV) pain medication. By the next day, oral pain medication is usually sufficient. Once pain is under control and bowel function begins to return, patients are ready for discharge.
Patients are discharged home with the urinary catheter, which usually remains in place for about one week. Patients then return to their urologist to ensure adequate healing has occurred and the catheter can be removed. During this time, patients are encouraged to walk often. They may shower, but should avoid swimming or sitting in a bathtub. If the cystogram reveals adequate healing, the catheter is removed.
Once the catheter is removed, urinary control returns after varying lengths of time. Patients are encouraged to initially wear an absorbent pad for protection while they work to retrain the muscles involved in urinary control. Kegel exercises, which strengthen the muscles supporting the urethra, bladder and rectum, are quite helpful. Heavy lifting should be avoided for about four weeks to avoid a hernia forming at the incision sites as they heal.
At the time of the catheter removal, the pathology report concerning the stage of the cancer is shared with the patient. While follow-up treatment will be based on the report results, most patients only need to have the PSA level checked on a regular basis. The first follow-up PSA should be checked three months after surgery and then every six months for the immediate future.
Physicians Performing the Procedure
Froedtert & the Medical College of Wisconsin
Medical College of Wisconsin Cancer Network Urologic Oncologists
Kenneth Jacobsohn, MD, urologist
Peter Langenstroer, MD, MS, urologist
Medical College of Wisconsin Urologists
Jeffrey Bejma, MD
Mark Dykstra, MD, urologist
Kevin Gee, MD, urologist
Christopher M. Kearns, MD, urologist
Sameer Sharma, MD, urologist
Alex Zacharias, MD, urologist (also performs robotic-assisted kidney surgery)