Da Vinci Robotic Surgery is a well established surgical technique for a wide range of surgical applications. Utilised in Urology for prostatectomy it also can be used for bladder cancer removal (robotic cystectomy) and renal surgery (Robotic assisted partial nephrectomy and pyeloplasty). Staffordshire Urology Clinic surgeons have undergone simulator training, international courses and on site mentorship from some of the leading prostatectomy surgeons from across Europe. The simplicity of the system allows surgeons to develop the technique much more rapidly than either the previously popular open or laparoscopic approaches.
It aims to cure prostate cancer by removing the entire prostate, surrounding glands (seminal vesicles) and sometimes lymph glands. Surgery can also correct any obstruction to the flow of water that is caused by prostate enlargement. Alternatives to this surgery are active surveillance, radiotherapy (including brachytherapy), HIFU and cryotherapy. All these therapies, with their relative risks and benefits, should be discussed and considered before choosing the best individual treatment.
Radical prostatectomy is now the commonest major urological operation performed in many specialist hospitals in the UK. It can be performed either by an open operation or keyhole (laparoscopic and robotic). Most, but not all patients, are suitable for all types of surgery and your surgeon will be able to advise about the best approach. The keyhole and robotic techniques combines the cancer curing advantages of an open operation with better vision for the surgeon and reduced blood loss during the operation. Other advantages of keyhole and robotic surgery are smaller scars (better cosmesis and lower risk of hernias and infection), shorter hospital stay and quicker general recovery time.
Before the operation you will be invited to come to the hospital for a pre-operative assessment (including blood tests and heart trace). It is advisable to perform pelvic floor exercises, which are critical to regain continence following surgery, before and after the operation. On the day of the operation you will be asked to give written consent for the operation. You will be given some suppositories, which help clear the bowel before surgery. The operation is performed under general anaesthesia and usually takes between 3 and 4 hours. You will wake up with a catheter tube draining urine from the bladder that will stay for 7-14 days post-op. Pain is usually minimal and controlled by tablets. Patients are often fit to go home a day or 2 after surgery. There are risks and side effects associated with all forms of treatment and these should be carefully considered before surgery. Serious complications associated with major surgery (heart, lung, and thrombosis problems that could lead to death) are very rare. Damage to the back passage (rectum) or other internal organs is likewise rare. The commonest adverse effects of this surgery are incontinence, infertility and impotence. Incontinence usually improves in the first year after surgery, spontaneous erections rarely return and infertility is permanent.
During the procedure, whilst under general anaesthetic 5 small holes are used to introduce instruments into the pelvis. These instruments are used to cut around the prostate and remove it, putting it first in a small bag. Some of the pelvic lymph glands may also be removed at the same time to check for signs of cancer spread. The bladder is then sutured to the urethra, leaving a catheter in the penis.
Regular follow-up with PSA blood test monitoring is required to ensure that the cancer has been eradicated. If the PSA fails to fall to very low levels (ideally less than 0.1 ng/ml, although many Doctors accept less than 0.2 ng/ml), or if it rises after being lower than this level, it is possible that the cancer is recurring. Early detection of cancer recurrence can often be salvaged and cure achieved by radiotherapy. Incontinence is a common early problem and you will be taught pelvic floor exercises to treat this. These exercises are critical and should be continued lifelong after this surgery. It is rare that incontinence fails to improve in the first year after this surgery, but if this is the case there are operations that might help. Impotence is also a common problem. This can sometimes be treated with tablets, but if these do not work then a vacuum device or injection into the penis can be very effective.