daVinci Robotic Prostatectomy is the surgical removal of the prostate gland, seminal vesicles, and sometimes the neighboring lymph nodes for the purpose of curing prostate cancer. During a traditional “open” Prostatectomy, the surgeon will make a large incision through the abdomen to reach the prostate. With daVinci robotic surgery, the surgeon operates through 5 small ¼” incisions. The daVinci robot is a tool which enables the surgeon to have significantly better visualization (12 times the normal magnification) and improved dexterity (the wristed instruments have 7 degrees of freedom and 90 degrees of articulation).
The operation entails removal of the seminal vesicles and prostate while selectively preserving the muscles that help maintain urinary control, and the nerves that help with erectile function (Neurovascular bundle). The prostate sits between the bladder and the penis, with a portion of the urethra running through it like a tunnel. When the prostate is removed during surgery, the bladder is re-attached to the urethra with stitches, just as in open surgery, except with the magnification and delicate precision of laparoscopic surgery and daVinci Robotics.
Advantages of a daVinci Robotic Prostatectomy
- Published data from surgeons experienced with daVinci Robotic Prostatectomy shows that negative margin rates with daVinci surgery are equal to, and in some reports, better than that of traditional open surgery.
- There is less blood loss than traditional open surgery and rarely the need for a blood transfusion.
- There is less pain after daVinci surgery.
- Patients typically require a hospital stay of only 1 day.
- Patients usually have a catheter for just 1 week.
- Abdominal scarring is minimized giving an improved cosmetic result.
Complications associated with daVinci Robotic Prostatectomy
- <1% chance of delayed return of bowel function
- <1% chance of bowel injury
- <1% chance of injury to bladder or ureters requiring additional surgery
- <1% change of prolonged urinary leakage requiring extension of the hospital stay by a few days or continued catheter drainage for a slightly longer period
- <1% chance of bleeding resulting in hematoma or blood transfusion
- <1% chance of wound infection or hernia formation
- <3% chance of urethra stricture
- <5% of patients have incomplete return of urinary control 12 months after surgery
The Urology Team Robotic Surgery Program:
Dr. Giesler has created a state of the art robotic surgery program here at the Urology Team. Given that no two patients are alike, the program is personalized to each patient.
Prior to surgery, we arrange for every patient to have a prostate MRI to better define the cancer and patient’s anatomy. Every patient sees a highly specialized physical therapist to evaluate their pelvic floor strength and learn how to do pelvic floor exercises correctly. Studies have shown that the addition of pelvic floor rehabilitation hastens one’s return to complete incontinence. A majority of our patients are socially continent by 6 to 8 weeks.
Our surgery coordinators will arrange for the appropriate pre-operative hospital visit to meet with nursing and anesthesia personal. For out of town patients, we help locate convenient hotels for the patient and their significant others.
The day of surgery, Dr. Giesler will personally meet with each patient prior to going to the operating room. Most surgeries last two to three hours. A majority of patients stay in the hospital only for 24 hrs. However, a patient is only discharged if they are medically stable, tolerating oral intake, have excellent pain control with oral medication and are confident to go home.
The patient will have a urinary catheter for approximately 7 days. This will divert the flow of urine away from the surgery site allowing the urethra to heal.
Dr. Giesler will give you detailed instructions prior to the post surgery follow-up visit.
Pain – Most individuals report some “gas” like pain the night following surgery, similar to doing too many sit-ups. Pain medication will be prescribed if over-the-counter medicine is ineffective.
Activity – Light activity can generally be resumed within 24 hours of your hospital release. Although patients may feel good on the outside, delicate work has been done on the inside that needs to heal. Full activity is usually allowed after three to four weeks. No lifting more than 25 lbs. or straddling are allowed for 4 weeks.
Medications – Three medications are prescribed after surgery.
Tramadol: a pain medication that can be safely taken with ibuprofen and acetaminophen.
Oxybutynin: a medication to help with any bladder spasms/cramps a patient may experience.
Macrobid: a twice a day antibiotic a patient takes while the catheter is in place.
At the first follow up visit, the catheter will be removed and the final pathology will be reviewed.
The patient will meet with the pelvic floor therapist 1-2 weeks after surgery for their first evaluation. Most patients will need to see a therapist for 4 to 6 visits.
Three months after surgery, the patient will get a PSA and follow up with Dr. Giesler. The expected PSA is <0.1.
daVinci Robotic Prostatectomy requires special training, and patient outcomes correlate to the number of daVinci Prostatectomies performed by the surgeon. That is why at the philosophy of the Urology Team is to have select doctors be the ones to performs certain specialized procedures. Dr. Giesler performs the daVinci robotic prostatectomies for our group.
Surgery may not be appropriate for all patients. Risks and benefits vary from patient to patient and should be discussed with your surgeon prior to deciding on this operative procedure.