ROBOTIC PROSTATE SURGERY

This operation needs specialised training, as the surgeon is unable to “feel” your tissues or organs unlike open surgery. It is only suitable for certain prostate tumours and your surgeon will tell you if you are suitable.

Some of the advantages of robotic surgery include:

  • Clinically superior results
  • Reduced risk of complications
  • Quicker recovery period
  • Minimised scarring

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ADDITIONAL INFORMATION

Advantages

  1. Avoids open surgery and the resulting large scar and muscle damage. Smaller scars from the ports will be visible
  2. Shorter hospital stay of usually 3-4 days
  3. Less pain after the operation.
  4. Quicker full recovery and earlier return to work
  5. Quicker and more precise suturing than is possible with standard laparoscopy.

Risks of the Procedure

As in any complex surgery there are a few risks of which the common ones are:

  1. Bleeding and blood transfusion (<5%). Occasionally a bleeding blood vessel can be stopped in the x-ray department by blocking the bleeding vessel using angiography (blood vessel imaging).
  2. Damage to structures around the kidney: spleen, colon, liver, pancreas, bowel (2%)
  3. Urinary leak around the kidney or bleeding into the ureter tube, if removing the tumour causes entry into the kidney’s urine collecting system (3-5%). This may require a prolonged hospital stay, insertion of a ureteric stent (internal drainage tube into the ureter) or re-insertion of a drainage tube through the skin.
  4. Conversion to open surgery due to robot failure, bleeding, or other complications.
  5. Total/radical nephrectomy if partial nephrectomy is not technically possible
  6. Anaesthetic complications: including irregular heartbeat, chest infection, blood clots in the legs/lungs.
  7. 10-20% chance that the tumour removed is not cancerous and is a relatively harmless benign growth.
  8. Late complications: port site hernia, scaring, cancer recurrence.
  9. The risk of dying from laparoscopic urologic surgery is extremely low and is roughly between 0.03-0.08%

Please ask any questions that you wish prior to consenting for your operation.

Preparing for your surgery

Your consultant should discuss the details of the procedure with you in outpatients outlining the procedure as part of your consent.

You should have attended a pre-assessment clinic prior to your admission to hospital to assess your suitability for this procedure and fitness to undergo general anaesthesia and surgery.

Prior to your surgery you will need to sign a consent form and have your skin marked at the site of the surgery. This consent gives the consultant permission to operate on you. Before you sign this, please ensure that you fully understand the procedure you are about to undergo. If you do have any questions, concerns please ask your consulting team to clarify them for you.

The day of your surgery

You may eat and drink, as you desire the evening prior to surgery however a minimum of 6 hours prior to your surgery you will need to be Nil By Mouth (NBM), which is to have nothing at all by mouth prior to surgery. A full general anaesthetic is required for robotic partial nephrectomy.

What can I expect after getting home?

You should not forget that although you may feel well and have no large scar, you still have had major surgery.

You will need a period of time to recover fully before returning to normal activities. You should be active within your home and build up to returning to your usual tasks.

You may have some pain associated with the surgery and also occasional bouts of lethargy are not uncommon after major surgery. You may need to rest/sleep more than usual in the first 2 weeks after the operation.

Does the robot do the surgery?

No, the surgeon does the operation. The robot is an instrument that allows the surgeon to operate in small spaces in the body. It essentially makes the surgeon’s hands two seven-millimeter instruments. The robot is controlled by the surgeon and does not work on its own.

How much pain will I be in?

Since the surgery is done through a small incision, most patients experience much less post procedure pain then with open surgery. You will have regular painkillers by mouth or injection for the first few days. Patients tend to need much less pain medication. After one week, most are feeling no pain at all.

When can I exercise?

Light walking is encouraged right after the procedure. After 2 weeks brisk walking is recommended. After four weeks, jogging, aerobic exercise and heavy lifting can resume.

Can I shower or bath?

Yes, the stitches in your tummy are either dissolvable or waterproof clips, we just asked that you rinse thoroughly the soap from your body as this may irritate the wounds and that you pat yourself completely dry.

When can I drive?

When you are comfortable to do so; and when able to make an emergency stop. Please also check with your insurance company before returning to drive.

When can I resume sexual activity?

This will depend on when both you and your partner feel comfortable but is safe after the first week.

When can I return to work?

Please allow a couple of weeks’ recuperation before returning to work. If you work entails lifting please speak to your consultant prior to leaving hospital

Clinically Superior Results With Robotic Prostate Cancer Surgery

Dr Thanigasalam using the da Vinci robotic system is able to provide superior clinical prostate cancer treatment results when compared to traditional non-robotic procedures. This is because the da Vinci system’s Surgeon Console is equipped to provide the surgeon with a revolutionary, three-dimensional, multi-level magnification spectrum. More traditional scope-assisted surgery typically provides a much lower resolution image, and a more limited field of vision. Furthermore, the da Vinci system’s sensitive electronics and <1cm diameter surgical arms allow the surgeon to make highly precise movements inside the abdomen during the surgery. This means that the malignant tissue can be removed with an efficiency and ease, which was not possible prior to the era of robotic surgery. This greater precision helps in reducing the likelihood of relapse due to missed cancerous tissue.

Reduced Risk of Complications With Robotic Prostate Surgery

For prostate cancer treatment, surgery can be the most effective choice for eradicating malignant tumours without having to use chemotherapy and radiation therapy. The risks of infection, requiring a blood transfusion & bowel complications is significantly less with robotic surgery when compared with open surgery.

Quicker Recovery Period After Robotic Prostate Surgery

The da Vinci robotic technology optimises the chances of a quicker recovery time as opposed to traditional surgical prostatectomy. The smaller incisions required to manoeuvre the operating arms heal much faster, require fewer sutures and, therefore are less vulnerable to tearing or infection. The precise movements of the robotic arms allow a more targeted approach for cleaner removal of malignant tissue and reduces damage to healthy tissue surrounding the prostate during robotic prostate surgery. The operating arms of the da Vinci Surgical System are designed to avoid contact between the operating instruments and the walls of the incision. All of these advantages translate to a speedier and less worrisome recovery period.

Minimal Scarring After Robotic Prostate Cancer Surgery

unnamed (1)The sheer size of the incision needed for a traditional prostatectomy produces significant scarring in the patient’s lower abdomen, while the robotic prostate surgery procedure leaves incisions which heal with minimal visible scarring. In addition to the obvious aesthetic value, minimizing scar tissue on the interior walls of the incision promotes better healing. By minimizing the size of the incision needed to remove cancerous tissue, the risk of scar tissue-related complications is greatly reduced.

Surgeon Console For Robotic Prostate Surgery

The surgeon operates while seated comfortably at the da Vinci Surgeon Console, an ergonomically designed console viewing a 3-D image of the operative site. As the surgeon moves his hands, wrists and fingers, the instruments are performing the same movements inside the patient’s body. The da Vinci Robotic System is able to scale the doctor’s motions and translate them to the operating arms during robotic prostate surgery.

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Patient-side Cart

This part of the robot provides the instrument arms that are completely under the control of the surgeon. The laparoscopic arms pivot at the operating ports eliminating the use of the patient’s body wall for leverage and minimizing tissue damage. The skilled assistant surgeon is responsible for installing the robotic  instruments, preparing the robotic ports in the patient, as well as supervising the laparoscopic arms and tools.

High resolution 3-D Endoscope

This component provides true 3-D images of the operative field during robotic prostate surgery. Operative images are enhanced, refined and optimized using image synchronizers, high intensity illuminators and camera control units during the course of the robotic assisted surgery.