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.
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Are You a Candidate for da Vinci Surgery?
The following physicians are trained to use the da Vinci
Surgical System at Lourdes for urological procedures:
- James Steinmetz, MD
- Peter Lethin, MD
|
Broome Urological Associates
DePaul Pavilion
169 Riverside Drive
Binghamton, NY
607-729-7666
www.broomeurology.com
|
Only you and your doctor can decide if da Vinci Surgery may
be right for you.
3.
http://www.uant.com/urologic_oncology/robotic-da-vinci-prostate-kidney.php
5.
http://www.cancer.org/docroot/CRI/content/CRI_2_4_5X_What_happens_after_treatment_36.asp?rnav=cri%20
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.
