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What is Robot-Assisted Prostatectomy?
Robot-assisted prostatectomy is a minimally invasive surgery that uses surgical robotic arms to remove the entire prostate. The robot-assisted procedure helps surgeons operate through small ports rather than large incisions. Today, a robot-assisted radical prostatectomy is preferred over a traditional open surgery due to its several benefits, including less bleeding, less pain, shorter hospital stay, and faster recovery.
What are the Benefits of Robot-Assisted Prostatectomy?
Compared with traditional open surgery, robot-assisted prostatectomy has various benefits, including:-
- Less pain, as a result, there is no need for narcotic analgesics post-discharge.
- Less bleeding.
- Shorter duration of hospital stays.
- Faster recovery time - 90% of patients can resume full activity within two to three weeks.
- Surgery is performed with more precision.
- 94% of patients obtain complete continence within six months.
Who needs Robot-Assisted Prostatectomy?
Robot-assisted radical prostatectomy is used to remove all prostate cancer. During the prostatectomy procedure, the prostate gland and some tissue around the gland, including the seminal vesicles, are removed. The best results from a robot radical prostatectomy occur when your prostate cancer is in stage T1 or T2 (the cancer is confined to the prostate gland). The surgery is also performed to treat bladder and pelvic cancer.
Some other uncommon reasons for performing a robot-assisted prostatectomy include:-
- Recurrent bleeding from the prostate
- Unable to empty the bladder completely
- Very slow urination
- Bladder stones with prostate enlargement
- Hydronephrosis (urinary retention leading to increased pressure on the ureters and kidneys)
How is Robot-Assisted Prostatectomy Performed?
- The anesthesiologist will give you general anaesthesia to make you sleep throughout the procedure.
- Once you’re asleep, the team will give you antibiotics through an injection to prevent infection.
- Next, the surgeon will make five small incisions in your lower abdomen (belly).
- The surgeon will pass the robotic controlled camera and arms through these incisions to perform the procedure.
- Your surgeon will sit at a remote-control console a short distance from the operating table and control the surgical instruments’ motions.
- The console displays a magnified, 3D view of the surgical site, enabling the surgeon to visualise the procedure in much greater detail.
- He/she will remove your prostate by controlling one of the keyhole incisions.
- Finally, the surgeon will use absorbable stitches to hold the incision together under the skin.
What Can You Expect Before the Robotic-Assisted Surgery?
- You will have a consultation appointment with the anaesthesiologist for a pre-anaesthetic checkup.
- The doctor will ask you about your medical history and conduct a physical exam to ensure that you are in good health.
- Your medical team will ask you to stop eating or drinking anything after midnight the day before the surgery.
- Inform your doctor about all the medications (prescribed and over-the-counter) and herbal supplements you take.
- Your doctor will ask you to stop taking blood-thinning medications such as aspirin one week before the surgery.
- If you smoke, your provider will ask you to stop smoking as soon as possible before the procedure to improve the healing process.
- The doctor will briefly explain the procedure, duration, estimated cost, and insurance formalities.
- Based on your condition, the doctor may have other specific instructions for preparation.
What Can You Expect on the Day of the Robotic-Assisted Surgery?
- On the day of the surgery, you will be asked to sign a consent form giving your permission for the surgery.
- You will be informed about the change of clothes into a hospital gown and removal of any jewellery.
- The team will inform you to empty your bladder before the procedure.
- If there is excess hair at the surgical site, someone from the team will shave it off.
- The doctor will record your last meal and give you a sedative to help you relax.
- If your provider has prescribed any medication, you will be expected to take it with a sip of water.
- The anaesthesiologist will monitor your vitals.
- The team will shift you to the OT room.
What Can You Expect During the Robot-Assisted Surgery?
- In the OT room, you will be placed in a supine position (patients lie on their back, face towards the ceiling), secured to the operating table with a steep Trendelenburg position (30-40 degrees in the head-down position).
- The team will start an intravenous (IV) line for fluids and medications in your arms or hands.
- You will be given general anaesthesia before the procedure.
- Once you are sedated, the medical team will insert a breathing tube down your throat into your lungs.
- Someone from the nursing team will clean the skin at the surgical site with an antiseptic solution.
- Throughout the procedure, the anaesthesiologist will monitor your vitals, including heart rate, breathing, and blood pressure.
- The surgeon will perform the final surgical procedure.
What Can You Expect After the Robot-Assisted Prostatectomy?
In the Hospital:-
- After the procedure, the team will shift you to the OT room, where the team will closely monitor your condition.
- You may receive pain medications if needed.
- Your activity will gradually increase, and the team will encourage you to walk around after the surgery. This will help the healing process and prevent the formation of blood clots after the procedure.
- You will stay in the hospital for a day or two.
- You will be given instructions for care of the incision site at home. The doctor will also provide you with follow-up instructions upon discharge.
- You will be discharged from the hospital with a urinary catheter in place.
- The doctor will provide specific bathing instructions to keep the incision clean and dry.
- After the surgery, you will probably have some leaking of urine. You will be taught Kegel’s exercises to strengthen the muscles and gain urine control.
- You may experience some swelling and tenderness of the testicles after the surgery.
- You should postpone heavier exercises for about 3-4 weeks.
- Avoid climbing stairs as part of the exercise.
- Avoid using bathtubs, hot tubs, and swimming pools as long as you have a catheter in place.
- Avoid sitting still in a position for more than 45 minutes.
- You may experience temporary erectile problems after the surgery.
First Follow-Up Appointment
Your first follow-up appointment will be typically scheduled a week after the procedure. The doctor will remove the catheter during the visit, and the nursing staff will examine how well your bladder is emptying.
When to Consult the Doctor?
Call your healthcare professional if you experience the following symptoms:-
- Fever or chills
- Increasing abdominal pain
- Swelling in the abdomen
- Swelling in the legs
- Inability to urinate once the catheter is removed
- Bleeding or discharge from the incision site