Robotic Assisted Laparoscopic Prostatectomy

What is the prostate?

The prostate is a chestnut-sized gland that is part of the male reproductive system. Its function is to produce a fluid that is part of male ejaculate or semen. It is located below the bladder neck and surrounds the urethra (tube the urine passes through).

Prostate cancer is a disease in which cancer cells form inside the prostate. When prostate cancer is detected early, prostatectomy – surgical removal of the prostate gland- offers a potential cure.

What is a robotic assisted laparoscopic prostatectomy?

A prostatectomy is the surgical removal of the prostate gland. The seminal vesicles and the vas deferens (tubes) are also removed. The latest da Vinci Xi robot is used to perform the operation with the aid of a robot through keyhole ports. The surgeon operates through a few small incisions in the abdomen by using long instruments and a tiny camera.

The theoretical Benefits of Da Vinci Surgery include:

Nerve sparing technique

Some tumours can be removed by using a nerve sparing technique. This is performed carefully by cutting around the prostate and leaving as much nerves intact as possible. These nerves control male erectile function and aid with urinary continence. The amount of tissue removed will depend on the degree of cancer spread. This surgery benefits cancer that is likely contained within the prostate but carries the risk of leaving cancer behind if it is more advanced. Your surgeon will discuss the most appropriate approach.

Before the procedure

Please sign the consent form that gives your permission to perform the operation. Read the form carefully and ask questions if something isn’t clear. Take the admission booklet to the hospital to book the operation.
In addition to a complete medical history, your doctor may perform a physical examination to ensure you are in good health before you undergo the procedure. You may also undergo further blood tests and other diagnostic tests.
You will be asked to fast for at least 6 hours before the procedure, generally after midnight. The Lingard hospital will call the day before to advise when to stop eating and when to come into the hospital.
Inform your doctor if you are allergic to any medications, latex, tape and anesthetic agents.
Inform your doctor of all medications (prescribed and over the counter) and herbal supplements.
Notify your doctor if you have a history of bleeding disorders or if you’re taking any anticoagulant (blood-thinning) medications, aspirin, other medications or herbal preparations that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
If you smoke, you should stop smoking as soon as possible prior to the procedure in order to improve your chances for a successful recovery from surgery and to improve your overall health status.
You will be provided with information regarding Pelvic Floor Exercises. We encourage you to start performing the exercises as soon as possible before your surgery.

Operation Day

You will be given intravenous fluids and anaesthetised for your surgery. Usually, the anaesthetic doctor will see you or speak to you over the phone beforehand.
After the operation you will return to the ward with intravenous fluids with pain relief you can independently administer when needed. This is called patient controlled analgesia (PCA).
Small adhesive abdominal dressings will be placed over the incision sites and a small drain which will be removed in the next few days. The dressings may be changed before discharge.
You will have a catheter in place with a urine bag that will be changed to a leg bag before discharge.
Sitting out of bed and walking short distances around the ward will also help prevent clots. Deep breathing and coughing exercises is recommended to help prevent collapse of the lungs.

After discharge

Wound Care

The dressings are usually water-resistant and you you can shower normally.
Keep your dressings intact if possible. You can remove or change dressings if required e.g. if peeling, moist or lifting
The sutures are dissolvable.
Call Lake Macquarie Urology if you have any problems with your wounds.

Bowel Care

It is common for your appetite and bowel movements to recover gradually in the first week after surgery. Bowel movements may not resume until 3-5 days and is often a combination of change in diet, the operation and pain relief medications.
Try to avoid constipation as it can increase your risk of problems such as bleeding. Drink plenty of water and if necessary take laxatives such as Metamucil, Coloxyl or Movicol as directed. Many of these can be bought over the counter at your pharmacy.

Scrotal Swelling is common for up to a week following surgery. Supportive net pants can be provided by your nurse if needed for extra support. Avoid tight briefs as this may pull on the catheter.

Bladder Spasms are a cramping feeling that can last for several days or weeks before urethral catheter is removed. Bladder spasms are a natural response of the bladder healing and the catheter. These can be felt as urgency to urinate or pelvic pain. In severe circumstances, medications can be prescribed to alleviate the pain. Always check that there is free drainage of urine into the bag, as the bladder pain without urine drainage may indicate a problem such as a catheter blockage.

Activity Restrictions: It is expected that you will resume gentle activities around your home after you have been discharged from hospital. Gradually, increase the amount of walking you do each day, as tolerated. Do not walk to the point of exhaustion and avoid heavy lifting. We recommend that you wear your anti-embolic stockings until you are as active as you were before surgery.

Urinary catheter care

A nurse will show you how to change and care for your catheter bags prior to discharge.
The leg bag attaches to the catheter and will stay in place for approximately 2-3 weeks.
You will be given one spare leg bag as this must be changed at the end of each week. Your nurse will document on discharge what day to change your leg bag.
Empty your leg bag into the toilet when necessary.
Each night you will be given enough disposable overnight bags to last until the day of your catheter removal. This is a one use only bag and disposed of the next day.
Remember to open the drainage valve on the leg bag so it will drain into the bigger bag overnight.
Each morning you will close the drainage valve on the leg bag and disconnect the overnight bag and discard.
Always wash your hands well with soap and water before, and after emptying or changing the bags.

Follow up

Your catheter will be in place for approximately two weeks until removed by the nurse when you attend your follow up appointment with your surgeon.
Please bring a pad with you on the day as urine leakage is expected after catheter removal.
Restart your pelvic floor exercises and ensure a follow up appointment with your physiotherapist.

Side effects and risks

Infertility – Due to the closure of the vas deferens and the removal of the seminal vesicles sperm can no longer be ejaculated.
Dry Ejaculations – There will be no seminal fluid ejaculated on orgasm
Bladder Neck Stenosis – The bladder neck is a group of muscles that connect the bladder to the urethra. The muscles tighten to hold urine in the bladder, and relax to release it. Problems may occur if scarring develops and prevents the urine from emptying.
Loss of Bladder Control – Nerves and muscles needed for bladder control are located around the prostate. Changes can occur to the area and surrounding tissue. The degree of incontinence is highly variable for each person. It is usually experienced for 3-12 months.
Erectile Dysfunction often occurs after this surgery. The nerves responsible for erections are located along each side of the prostate. There are multiple options available and your surgeon and nurse will discuss what best suits your lifestyle.

Follow-up call

A nurse will provide a follow-up call to you after the operation. It is a good idea to write down anything you want to ask and have it ready.