Robotic Prostatectomy

What is a robotic prostatectomy?

The prostate gland is found only in men. It sits below the bladder and wraps around the urethra. The prostate helps make semen. Prostatectomy is surgery to remove the prostate gland. During the procedure, the seminal vesicles, nearby tissues, and sometimes pelvic lymph nodes are also removed. When prostate cancer spreads, the pelvic lymph nodes are often one of the first places it goes.

The prostate can be removed in two ways:

• Open procedure. The surgeon makes a single large cut (incision) into the lower belly (abdomen) to reach the prostate.

• Robotic prostatectomy. This surgery makes several smaller cuts and removes the prostate using a laparoscope. This is a thin tube with a tiny camera in it. Long, thin surgical tools at the end of the laparoscope are used to remove the prostate. Your surgeon can move these tools with the help of a robot. The surgeon uses controls and a computer screen to move the small tools. You will want to find a surgeon who has experience doing this type of surgery.

Why might I need a robotic prostatectomy?

Prostatectomy is used to treat prostate cancer that is confined to the prostate gland and the seminal vesicles. The robotic system can help your surgeon in several ways. The camera magnifies the area, helping the surgeon see tiny structures more clearly. The robotic system can make steady, precise movements in small places that the surgeon may have trouble reaching otherwise.

Compared with a standard open surgery, this type of surgery may have benefits. These include:

• Faster recovery

• Less bleeding

• Less pain

• Shorter hospital stay

What are the risks of a robotic prostatectomy?

During this surgery, medicines may be used to put you in a deep sleep called general anesthesia. In rare cases, spinal or epidural anesthesia may be used to make you numb from the waist down. Risks from this procedure include:

• Blood clots

• Bleeding

• Infection

• Injury to nearby organs, such as the large intestines

• Reactions to medicines used during the surgery

• Stroke or heart attack during the procedure

Some side effects that you may have after surgery include:

• Change in penis length

• Injury to the rectum

• Fertility loss

• Narrowing of the tube (urethra) in the penis that carries out urine

• Swelling in the leg or genital area caused by removal of the lymph nodes (lymphedema), this is rare

• Trouble controlling bowel movements

• Trouble controlling urine, called incontinence

• Trouble getting or keeping an erection

There may be other risks, depending on your specific health condition. Talk with your healthcare provider about any concerns before the surgery.

How do I get ready for a robotic prostatectomy?

• Your healthcare provider will give you a checkup before the surgery. This is to see that you’re healthy enough for the procedure. And that any health problems you have are under control. You will also have tests done to make sure the cancer has not spread to other parts of your body.

• Your provider will explain the procedure to you and give you a chance to ask questions.

• You will be asked to sign a consent form before the test. Read the form carefully. Ask questions if anything is not clear.

• Tell your healthcare provider if you are sensitive to or allergic to any medicines, latex, tape, and local or general anesthesia.

• Check that your provider has a list of all medicines, herbs, vitamins, and supplements that you are taking. This includes both prescribed and over-the-counter medicine.

• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any blood-thinning (anticoagulant) medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop these medicines before the surgery.

• If you smoke, stop as soon as possible. This will improve your recovery and your overall health.

• Your provider will tell you about any other specific things you need to do to get ready for surgery. For instance, the day before the surgery, you may need to take a laxative or bowel preparation to clear your colon.

• Follow any directions you are given for not eating or drinking before the surgery.

Based on your medical condition, your healthcare provider may ask for other specific preparation.

What happens during a robotic prostatectomy?

Robotic prostatectomy needs a hospital stay. Procedures may vary depending on your condition and your healthcare provider’s practices.

Generally, robotic prostatectomy follows this process:

1. You will be asked to remove any jewelry or other objects that might get in the way during procedure.

2. You will remove your clothing and put on a hospital gown.

3. You will be asked to empty your bladder.

4. An IV (intravenous) line will be started in your arm or hand. Antibiotics and medicines to reduce your risk of blood clots may be given.

5. You will be given anesthesia that puts you to sleep for the procedure. Or that makes you relax and feel numb from the waist down.

6. Your heart rate, blood pressure, breathing rate, and oxygen level will be watched closely during the procedure.

7. You will most likely lie on your back on a special table that holds your legs apart.

8. A soft, flexible tube called a catheter will be put into your bladder to drain urine.

9. If there is a lot of hair at the incision sites, it may be shaved off.

10. The skin over the surgical site will be cleaned with an antiseptic solution.

11. The surgeon will then make several small cuts into your lower belly.

12. The robotic arms will be placed over you, and the video camera and instruments will be put into your belly through these cuts.

13. The surgeon will cut away your prostate, the seminal vesicles, and some nearby lymph nodes and take them out through the small cuts. The urethra will be sewn to the bladder. A new catheter will be placed into the bladder.

14. All of the tools will be removed, and the cuts will be closed with skin glue, stitches, or small strips of tape.

15. A bandage or dressing will be put on the sites.

What happens after a robotic prostatectomy?

After the surgery, you will be taken to a recovery room to be closely watched. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.

You may get pain medicine, as needed, by a nurse. Or you may give it yourself through a device connected to your IV line.

You can slowly eat solid foods as you are able to handle them.

After the surgery, your healthcare team will show you how to do breathing exercises and movements while in bed to help your body recover. You may wear special stockings on your legs that reduce your risk for blood clots. After resting the first day, you may be encouraged to get up and move around. You may be able to go home the day after the surgery.

The catheter that was put in to drain your urine will stay in place for a week or two as you heal. You will be taught how to drain the catheter bag. Once it's removed, you may have trouble controlling your urine. Your healthcare team can show you how to do pelvic floor muscle exercises to better control your urine.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how will you get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure