What to Expect from a da Vinci® Prostatectomy Procedure
Undergoing any sort of surgery can cause anxiety. Pursuing treatment with
a surgical approach that is still new and unknown to many patients may
further raise a number of questions. This section explains what happens
before, during and after a robotic-assisted surgery using the da Vinci®
Surgical System, and aims to dispel some of that anxiety by providing clear
information on what you should expect from your procedure.
Initial Appointment
Many men simply go to a primary care physician for a routine check-up,
only to get a call a few days later to report that something called an
“elevated PSA” had shown up in their laboratory results and that further
testing will need to be conducted by a urologist.
Laboratory Results
The exam likely consists of a standard digital rectal exam (DRE), in
which the doctor manually palpates the prostate by way of the rectum. Even
if the urologist detects nothing abnormal, he/she schedules a biopsy to be
on the safe side. The biopsy is performed by inserting a tubular structure
in the rectum, from which projectile needles collect 5-6 “cores” of tissue
from each side of the prostate. Although many patients tolerate the biopsy
without medication, the urologist may offer something to alleviate any
discomfort and/or anxiety associated with the procedure.
Treatment Options
If the patient has an early diagnosis of prostate cancer, there is
usually a range of treatment options. These may include conservative
management, radiation therapy with external bream or brachytherapy,
cryosurgery and prostatectomy - surgical removal of the prostate. The
treatment options will depend on a number of factors, including the stage of
the disease, the age and health or personal preference of the patient.
Pre-Operative
The patient will have a physical examination and discuss the surgery and anesthesia with their surgeon. The patient will be scheduled for a
pre-admission testing appointment in which various tests will be performed
based on the needs of the patient. The evening before surgery the patient
follows instructions for bowel preparation as provided by the doctor.
Day of Surgery
Shortly before the operation, anesthesia is administered and the patient
goes to sleep for the duration of the operation, which typically lasts 2-4
hours. The procedure begins when the patient’s abdomen is inflated with
carbon dioxide gas, creating an operating space for the surgeon. Next, six
small incisions, 1/4 to 1/2 inch in length, are made in the patient’s
abdomen and ports are inserted to keep the incisions open.
During the procedure, the surgeon uses the da Vinci System’s laparoscopic
surgical instruments and video camera, via the temporary ports, to direct
the dissection of the prostate gland and adjacent tissue. If deemed
appropriate, the surgeon tries to preserve the nerves attached to the
patient’s prostate gland. At the end of the surgery, the ports are removed
from the patient’s abdomen and the remaining incisions are closed with
sutures.3
For detailed information about this procedure, please
talk to a surgeon who performs da Vinci Prostatectomy.
Post-Operative
The patient wakes up very groggy and with a urinary catheter in place. He
will likely spend one night in the hospital resting and recovering from the
effects of the anesthesia. As the anesthesia wears off, there may be some
discomfort, for which pain medication may be prescribed. During this time,
the medical team gets the patient sitting, standing and eventually walking
around, which is recommended throughout the recovery period. Because a
catheter typically remains in place for approximately 7 days, the doctor
will review guidelines for use that will ease discomfort and ensure proper
function of the catheter during this time.
Recovery Period
The first week post-operatively will likely be spent resting; however,
frequent walks are encouraged. Depending on the individual, regular
activities may resume as soon as soon as a few days after surgery; straining
and heavy lifting is discouraged for the first four weeks post-operatively.
Approximately one week after surgery, a post-operative follow-up is
scheduled, at which time bladder function may be assessed. This is done by
filling the bladder with saline via the catheter, removing the catheter and
then allowing the patient to void naturally. Some incontinence after surgery
is normal and is typically managed with medication until bladder control
resumes. Erectile dysfunction may also be a side effect of surgery. Like
incontinence, this side effect may be discussed with the doctor and managed
with medication until it lessens or completely resolves over time.
Follow-Up Care
After treatment for prostate cancer, the doctor will want to watch the
patient carefully, checking to see if his cancer recurs or spreads further.
The doctor should also outline a follow-up plan. This plan usually includes
regular doctor visits, PSA blood tests and digital rectal exams, which will
likely begin within a few months of finishing treatment. Most doctors
recommend PSA tests about every 6 months for the first 5 years after
treatment, and at least yearly after that.5
3.
http://www.uant.com/urologic_oncology/robotic-da-vinci-prostate-kidney.php
5.
http://www.cancer.org
While clinical studies support the effectiveness of
the da Vinci® System when used in minimally invasive surgery, individual
results may vary. Surgery with the da Vinci Surgical System may not be
appropriate for every individual. Always ask your doctor about all treatment
options, as well as their risks and benefits.