MelbourneROBOTICPROSTATECTOMY

The da Vinci Robot

The daVinci^® robot consists of the surgeon's console, the surgical cart and connections between the two.

The surgical cart is located beside the patient, and utilises one robotic arm to control the endoscope (which provides stereoscopic or 3-D vision) and two or three robotic arms to control surgical instruments. The surgical instruments are designed with jointed wrists, which provide freedom of movement in multiple directions (7 degrees of freedom).

The surgeon's console includes a binocular eyepiece that provides optimal vision during surgery. Ergonomically designed finger controls transform the surgeon's hand movements into corresponding movements of the surgical instruments within the patient's body.

Robotic Prostatectomy

Robotic prostatectomy starts with Dr Sengupta operating by the patient's bedside to place the operating ports in the appropriate positions and dock the surgical cart of the daVinci robot. Subsequently, Dr Sengupta operates using the robotic console, with an assistant surgeon helping at the bedside.

The actual surgery consists of the removal of the prostate with its surrounding layers, the seminal vesicles, the ends of the vasa and (in some cases) draining lymph glands, as for open radical prostatectomy. In suitable cases, the cavernosal nerves (responsible for erectile function), which run on the undersurface of the prostate, may be dissected and preserved to maximise recovery of post-operative sexual function.

Finally, the bladder and urethra (which are connected at either end of the prostate) are joined back together with a circumferential suture (called the anastomosis). Robotic surgery allows a very precise and watertight anastomosis, which minimises the risk of urine leakage and scarring in the area. A catheter is left to drain the bladder to allow the anastomosis to heal effectively. An additional drainage tube is placed through one of the operating ports to the space outside the bladder, in order to drain any fluid that collects post-operatively.

Pre-operative Preparation

A week or two before robotic prostatectomy, patients need to meet a urology nurse who works with Dr Sengupta. At this visit, you will receive information and counselling regarding the procedure and post-operative recovery. Pre-operative investigations such as blood tests and ECGs are also arranged.

A pre-operative consulation with a pelvic floor physiotherapist is also essential. This allows a thorough assessment of your pelvic floor strength, leading to instruction in pelvic floor exercises to improve this. This is an important factor assisting recovery of urine control (continence) post-operatively.

Admission to hospital is arranged in the 24 hours prior to surgery - please check details with Dr Sengupta's office. You will be allowed a light diet and given some laxatives in the 24hours prior to surgery. In hospital, you will meet and be assessed by the anaesthetist and peri-operative physician.

Post-operative Recovery

Following robotic prostatectomy, most patients can eat & drink and get out of bed within the first 24hours. Strong pain relief may be required for a day or two, beyond which tablets are usually adequate. Discharge from hospital occurs after 2-3days, with the catheter in place, but after removal of the drain tube.

The catheter is removed after about 10days at Dr Sengupta's office, with an antibiotic given by injection. It is usual to have poor urinary control at this stage, and pads are often necessary. Pelvic floor exercises should be started 2-3days after catheter removal, and will gradually lead to return of urinary continence over weeks to months.

Return to driving, work and exercise can occur between 2 and 4 weeks under Dr Sengupta's advice. Follow-up including a PSA check (which should be undetectable or zero) will be arranged between 2 to 3 months post-operatively.

Download printable information sheet on da Vinci robotic prostatectomy