This video will help give you an overview of what’s involved in robot-assisted laparoscopic radical prostatectomy—daVinci surgery for prostate cancer.
about the procedure
Facing any kind of urologic surgery creates a great deal of anxiety for most men. Among your concerns is: “Will my body function normally following surgery?” Traditional open urologic surgery—in which large incisions are made to access the pelvic organs—has been the standard approach when surgery is warranted. Yet common drawbacks of this procedure include significant post-surgical pain, a lengthy recovery and an unpredictable, potentially long-term impact on continence and sexual function. Robotic surgery, a minimally-invasive approach that utilizes the latest in surgical and robotics technologies, is ideal for delicate urologic surgery. This includes prostatectomy, in which the target site is not only tightly confined but also surrounded by nerves affecting urinary control and sexual function. The procedure is performed through 6 dime-sized incisions in the abdomen, and one of the incisions is widened slightly to remove the prostate itself. The procedure usually takes about 2 to 3 hours and you should expect to spend 1 night in the hospital.
Take only clear liquids on the day prior to the procedure. Acceptable liquids include tea or coffee (no milk or cream), water, apple juice, Gatorade or other sports drinks, popsicles, italian ice or chicken broth.
Drink five ounces of citrate of magnesium at 4:00 pm the day before the procedure. If this does not produce a bowel movement by 7:00 pm take an additional 2 ounces of citrate of magnesium. This is available over the counter in the laxative section of your pharmacy. Remember to drink plenty of clear liquids to stay hydrated while preparing for your procedure.
Do not eat or drink anything after midnight the night before the procedure. You should take your usual medications as you normally would the morning of your procedure with a small sip of water only (avoid juice, milk, coffee, etc.).
Starting 5 to 10 days prior to your procedure (ask your doctor for a specific time), it is important to stop taking medications that might increase your risk of bleeding. For a list of blood-thinning medications that should be avoided, click here or ask you doctor.
Additionally, your doctor may have prescribed for you an enema, which should be taken rectally 2 hours before coming in to the hospital on the day of your surgery. Check the packaging of the enema for specific instructions.
You will be discharged with a catheter in your bladder. This is typically left in place for 1 to 2 weeks.
The catheter should only be removed by your Urologist
Drink 6 to 8 glasses (1500cc) of fluid daily until the catheter is removed
If blood appears in your urine (red fluid in the tubing of the catheter), increase your fluid intake and decrease your activity level until it clears
Unless instructed otherwise, avoid taking aspirin, anti-inflammatory medications (ibuprofen, etc.), or blood thinners until you are seen in the office
Do not use any rectal suppositories or enemas
Remove the dressings from all incisions on the second day after surgery and leave the incisions open to air
Contact the office immediately you experience any of the following:
Swelling of one or both legs
Shortness of breath
Fevers higher than 100.5° F
Catheter stops draining
You can and should walk around freely (rest in bed only when tired)
You may climb up and down stairs slowly
You may shower with the catheter, but do not soak in a tub or take baths
You should not drive until your catheter has been removed (it is ok to ride in a car) or if you are taking narcotic pain medication
Avoid strenuous activity, exercise, and heavy lifting (more than 20 lbs.) for 4 weeks after your surgery
No bicycle or horseback riding for 8 weeks after surgery
You may eat your usual diet when at home
In addition to the pain medication, you should take the prescribed stool softener to prevent constipation
If you do not have a bowel movement within 3 days of your surgery, begin taking over-the-counter milk of magnesia twice daily until your fist bowel movement
Limiting the narcotic pain medication will help decrease constipation
While at home, keep the catheter connected to the large drainage bag
It is OK to use the smaller drainage bag if you plan on going out of the house
It is normal for your catheter to have pink to reddish urine, especially with increased activity or bowel movements
Decreasing your activity and increasing fluids will usually make the urine clear
You may notice pink discharge at the tip of the penis—this is normal
Applying over-the-counter antibacterial ointment (e.g. Neosporin or Bacitracin) 2 to 4 times daily to the tip of the penis will help decrease irritation
Leakage around the catheter
This is a common problem often related to bladder spasms (leakage may be accompanied by the urge to urinate or lower abdominal pain/cramping). If urine is still draining through the catheter tubing, as well as around it, use absorbent pads to stay dry. Increase you fluid intake and decrease your activity—the spams should pass
If the spasms are severe, call the office and a medication to help control them can be prescribed.
Swelling of the penis and/or scrotum is not unusual and should improve with time. It may help to elevate the scrotum with a soft towel behind the scrotum while seated or lying down
If an the skin of an incision should open, you may clean it with hydrogen peroxide and apply a clean gauze to cover it twice daily.
Bruising around the incision
This is normal and will get better with time.
This is common after surgery. Walking, increasing fluids, and decreasing the use of narcotic pain medications will usually help improve these symptoms (see Diet instructions above).
Your follow-up schedule after surgery can change depending on the final report of the type and amount of cancer present, but most patients are seen every 3 months for the first two years for review of PSA blood tests (which should drop to zero, indicating the cancer has not returned) and a physical exam. You will also discuss your progress with erectile and urinary rehabilitation with your surgeon. Visits are then extended to twice a year for two years, and then annually following the fifth year. Of course, the follow-up schedule is always tailored to fit your clinical needs.