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Robotic radical Prostatectomy is
the most preferred way of treating localized prostate cancer.
Robotic prostatectomy is performed with the help of a Surgical
Robot (da Vinci) through 4 to 5 small 1-cm keyhole incisions across
the abdomen. Through these small incisions, the robotic arms enter
the abdomen. The operating surgeon sitting at the operating console
controls the robotic instruments to precisely dissect the prostate
gland, seminal vesicles, and vasa deferentia from the urethra and
bladder.
Once the prostate gland is dissected free from the bladder, rectum,
and urethra, it is placed in a small plastic bag and eventually
removed intact by extending one of the keyhole incisions. The
complete prostate along with the lymph nodes are then sent to the
histopathologist for detailed examination. The bladder is sewn back
to the urethra to restore continuity of the urinary tract using
robotic instruments and absorbable suturing material. A Foley
catheter is placed through the penis to drain the bladder and allow
healing of the bladder-urethra connection. In addition, a small
drain is placed around the surgical site, exiting one of the keyhole
incisions.
Robotic surgery is performed adhering to the same anatomic
principles of open surgery, but without the surgeon’s hands entering
into the patient’s body cavity. Specially designed endowrist
instruments allow seven degrees of motion that mimic the dexterity
of the human hand and wrist. The result is a better anastomosis when
the bladder and the urethra are sewn together after removal of the
prostate. Thus the quality of open surgery is achieved without
giving a big surgical incision and its associated complications. In
fact, during robotic surgery, a high-resolution 3-D vision along
with 10-12 folds magnification provides true-to-life view of the
surgical field and gives the surgeon an excellent visualization and
details of the prostate gland and the surrounding neurovascular
structures, allowing for precise dissection of the prostate and
suturing of blood vessels.
The average length of surgery is 2.5 – 3 hours but it varies
from patient to patient (2.5 - 4,5 hours) depending on the size of
the prostate gland, shape of the pelvis, weight of the patient, and
presence of scarring or inflammation within the pelvis due to
infection or prior abdominal/pelvic surgery.
Blood loss during robotic prostatectomy is routinely less than
300 cc. Transfusions are rarely required. Donation of blood prior to
surgery for autologous blood transfusion can be arranged if the
patient desires, but is not recommended.
Pain: Another advantage of robotic surgery is much less pain
compared to open surgery. Immediate post surgery pain medication can
be controlled and delivered by the patient via an intravenous
patient-controlled analgesia (PCA) pump or by injections by the
nursing staff. Minor transient shoulder pain may be experience
related to carbon dioxide gas used to inflate the abdomen during
surgery.
Bladder spasms are experienced after prostatectomy as a
cramping sensation in the lower abdomen. These spasms are transient
and decrease over time. If severe, medication can be prescribed by
your doctor to decrease such episodes.
Gas Cramps :- You may experience sluggish bowels and gas cramps
for initial 2-3 days after surgery. Pain medications and effect of
anesthetic drugs also prolong the recovery of bowel functions.
Getting out of bed, walking, more fluids and stool softeners help in
the recovery.
Hospital Stay:- Typically a patient stays for 1-2 nights in the
hospital.
Back to normal activities:- One of several advantages of
robotic surgery is earlier return to normal activity. Patient is
expected to get out of bed and begin walking with the supervision
and help of nurse on the evening of surgery. Gradually the physical
activity is increased. Walking is strongly advised. In fact,
prolonged sitting or lying in bed should be avoided to decrease the
risk of forming blood clots in legs.
Driving should be avoided for 2 weeks after surgery. Most
patients return to full activity at an average of 3-4 weeks after
surgery.
Lifting heavy weights, strenuous exercises (jogging, biking, contact
sports etc) should be deferred for six weeks or until instruction by
doctor.
Diet & Bowel functions Oral liquids are allowed once you
recover from the effect of anesthetic drugs. It is advised to take
liquids and avoid high fiber diet in the beginning (till you have a
normal bowel movement). It may take 2-3 days for the intestines to
recover from the surgery and anesthesia. Pain medication, decreased
physical activity and dehydration may cause constipation. Therefore,
pain medication should be discontinued as soon as possible. Along
with lots of fluids and mild laxatives or stool softeners may help
in avoiding constipation. Once you have normal bowel movements, you
may return to your normal diet.
Radical Cystectomy is the gold
standard treatment for muscle invasive bladder cancer. It involves
removal of the bladder, prostate, seminal vesicles and surrounding
fat and attachments in men, and in women, also the uterus, cervix,
urethra and anterior vaginal wall. Radical surgery for bladder
cancer can be performed by open surgical techniques or by newer
advancements like Robotic surgery.
Robotic radical Cystectomy is the latest advancement in
technique of surgical removal of bladder and pelvic lymph nodes
which achieves comparable results while minimizing morbidity. In
this technique, we use the da Vinci Robotic surgical system which
imitates the surgeon’s movement on the operating console into fine
actions inside the body. The precision of surgery results in sparing
of vital but delicate nerves and tissue which in turn facilitates a
faster recovery, fewer complications and a shorter hospital stay.
Some of the benefits of Robot Assisted Radical Cystectomy include:
• Minimal damage to vital nerves and tissue
• Significantly reduced morbidity
• Less blood loss
• Reduced risk of infection
• Less postoperative pain and discomfort
• Fewer noticeable scars
• Advantage of high- definition 3D visualization and robot assisted
suturing for
better anatomists
Since, the bladder is removed; you will need an alternative way of
passing urine. This can be in the form of Ileal conduit or
Neobladder.
Robot assisted Radical Nephrectomy
is performed under general anesthesia. The typical duration of the
operation is 3-4 hours.
The surgery is performed through 3 to 5 small incisions (5-12 mm) made
in the abdomen. The robotic arms with its attached instruments (that
includes a camera) are passed through these “keyholes”. The camera
provides the surgeon a 3-dimensional, high definition, magnified
view of the tissues inside the body. Various types of Endowrist
instruments with capability to move in various directions allow the
surgeon to precisely dissect the kidney along with the tumor and
make it completely free without having to place his hands into the
abdomen. The dissected kidney, its surrounding fat and sometimes the
adrenal gland (if removed) are then placed in a sterile retrieval
bag and removed through a small incision. The entire kidney with the
tumor is then sent to the pathologist for complete examination and
to evaluate for detailed histopathological diagnosis.
Robotic pyeloplasty
involve the precise removal of the narrow or scarred segment of the
ureter (ureteropelvic junction or UPJ) and rejoining the healthy
segment of the upper ureter to the pelvis.
Robotic pyeloplasty is performed under a general anesthetic. The
typical length of the operation is 3-4 hours.
The surgery is performed through 3 small (5-12mm) incisions made in
the abdomen. The robotic arms with its attached instruments (that
includes a camera) are passed through these “keyholes”. The camera
provides the surgeon a 3-dimensional, high definition, magnified
view of the tissues inside the body. Various types of Endowrist
instruments with capability to move in various directions allow the
surgeon to precisely dissect the junction of the ureter and kidney
pelves and subsequently repair the blocked or narrow segment,
without having to place his hands into the abdomen.
A small hollow tube (called a ureteral stent) is left inside the
ureter at the end of the procedure to bridge and support the site of
repair and help drain the kidney. This stent is kept in place for
approximately 4 weeks and is usually removed in the doctor's office.
Immediately after the surgery, a small drain will also be left
exiting your flank to drain away any fluid around the kidney and
pyeloplasty repair.
For Detailed Dossier on
da
Vinci Si Surgical Robotic system,
please write to us at
mktg@mediescapes.com
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