What is a robotic prostatectomy?

The prostate gland is found only in males. It sits below the bladder and wraps around the urethra. The prostate helps make semen. Prostatectomy is surgery to remove the prostate gland. During the procedure, the seminal vesicles, nearby tissues, and sometimes pelvic lymph nodes are also removed. When prostate cancer spreads, the pelvic lymph nodes are often one of the first places it goes.

The prostate can be removed several ways. One way is for a surgeon to make a single large incision into the lower abdomen to reach the prostate. This is called an open procedure.

Another kind of surgery involves making several smaller cuts and removing the prostate using a laparoscope. This is a thin tube with a tiny camera in it. Long, thin surgical tools at the end of the laparoscope are used to remove the prostate. Your surgeon can operate these tools with the help of a robot. This is known as a robotic prostatectomy. The surgeon uses controls and a computer screen to move the small robotic tools. You want a surgeon who has had a lot of experience with robotic prostatectomy.

Why might I need a robotic prostatectomy?

Prostatectomy is used to treat prostate cancer that is confined to the prostate gland and the seminal vesicles. The robotic system can help your surgeon in several ways. The camera magnifies the area, helping the surgeon see tiny structures more clearly. The robotic system can make steady, precise movements in small places that the surgeon may have trouble reaching otherwise.

Compared with an open procedure, this type of surgery may have benefits including:

• Less bleeding

• Less pain

• Faster recovery

• Shorter hospital stay

What are the risks of a robotic prostatectomy?

During robotic prostatectomy, drugs may be used to put you in a deep sleep (called general anesthesia). Or, spinal or epidural anesthesia may be used to make you numb from the waist down. Risks from this procedure include:

• Reactions to medicines used during the surgery

• Blood clots

• Bleeding

• Infection

• Stroke or heart attack during the procedure

Some side effects that you may have after surgery include:

• Trouble controlling urine, called incontinence

• Trouble getting or keeping an erection

• Loss of fertility

• Change in penis length

• Trouble controlling bowel movements

• Injured rectum

• Narrowing of the urethra (the tube in the penis that carries out urine)

• Lymphedema (swelling in the leg or genital area caused by removal of the lymph nodes, this is rare)

There may be other risks, depending on your specific medical condition. Be sure to talk with your healthcare provider about any concerns before the surgery.

How do I get ready for a robotic prostatectomy?

• Your healthcare provider will give you a checkup before the surgery. This is to see that you're healthy enough for the procedure and that any health problems you have are under control. You will also have tests done to make sure the cancer has not spread to other parts of your body.

• Your healthcare provider will explain the procedure to you and give you a chance to ask questions.

• You will be asked to sign a consent form before the test. Read the form carefully and ask questions if anything is not clear.

• Tell your healthcare provider if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

• Make sure your healthcare provider has a list of all medications (prescribed and over-the-counter) and all herbs, vitamins, and supplements that you are taking.

• Tell your healthcare provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, ibuprofen, or other medications that affect blood clotting. You may need to stop these medications before the surgery.

• If you smoke, stop as soon as possible. This will improve your recovery and your overall health.

• Your healthcare provider will tell you about any other specific things you need to do to get ready for surgery. For instance, the day before the surgery, you may need to take a laxative to clear your colon. You may also be told to have only clear fluids the day before the surgery and to stop eating and drinking after midnight.

Based on your medical condition, your healthcare provider may request other specific preparation.

What happens during a robotic prostatectomy?

Robotic prostatectomy requires a stay in a hospital. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, robotic prostatectomy follows this process:

1. You will remove any jewelry or other objects that might get in the way during the procedure. A bracelet with your name and an ID number will be put on your wrist. You may get a second bracelet if you have allergies.

2. You will be take off your clothing and put on a hospital gown.

3. You'll be asked to empty your bladder.

4. Shortly before the surgery, an intravenous (IV) line will be put in your arm or hand. Antibiotics and medications to reduce your risk of blood clots may be given.

5. You will be given anesthesia that put you to sleep for the procedure or make you relax and feel numb from the waist down.

6. Your heart rate, blood pressure, breathing rate, and oxygen level will be monitored during the procedure.

7. You will most likely lie on your back on a special table that holds your legs apart.

8. A soft, flexible tube called a Foley catheter will be put into your bladder to drain urine.

9. If there is a lot of hair at the incision sites, it may be shaved off.

10. The skin over the surgical site will be cleaned with an antiseptic solution.

11. The surgeon will then make several small cuts into your lower abdomen.

12. The robotic arms will be placed over you, and the video camera and instruments will be put into your abdomen through these cuts.

13. The surgeon will cut away your prostate, the seminal vesicles, and some nearby lymph nodes and take them out through the small cuts.

14. All of the instruments will be removed and the cuts will be closed with sutures or small strips of tape.

15. A bandage or dressing will be put on the sites.

What happens after a robotic prostatectomy?

After the surgery, you will be taken to a recovery room to be closely monitored. Once your blood pressure, pulse, and breathing are stable and you are awake and alert, you will be taken to your hospital room.

You may get pain medication as needed, either by a nurse, or by giving it yourself through a device connected to your IV line.

You can gradually eat more solid foods as you're able to handle them.

After the surgery, your healthcare team will show you how to do breathing exercises and movements while in bed to help your body recover. You may wear special stockings on your legs that reduce your risk for blood clots. After resting the first day, you may be encouraged to get up and move around. You may be able to go home the day after the surgery.

The Foley catheter that was put in to drain your urine will stay in place for a week or two as you heal. Once the Foley is removed, you may have trouble controlling your urine. Your healthcare team can show you how to do Kegel exercises to better control your urine.

At home

Instructions for when you go home will likely include not driving for at least a week after the surgery. You will need to avoid heavy exercise for 3 or 4 weeks. You will also be taught how to care for the Foley catheter. Be sure to keep any follow-up appointments. The catheter will be taken out at one of these follow-up appointments.

Tell your healthcare provider if you have any of the following:

• Fever and/or chills (may be a sign of infection)

• Redness, swelling, or bleeding or drainage from the incisions

• Increase in pain around the incisions

• Inability to have a bowel movement

• Inability to urinate once catheter is removed

• Changes in your urine output, color, or odor

Your healthcare provider may give you other instructions after the procedure, depending on your particular situation.

Next steps

• The name of the test or procedure

• The reason you are having the test or procedure

• The risks and benefits of the test or procedure

• When and where you are to have the test or procedure and who will do it

• When and how will you get the results

• How much will you have to pay for the test or procedure

For more information go to www.riversidehealthcare.org/robotic-assisted-prostatectomy.html