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Robotic Prostatectomy

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At UF Health, our advanced team of urologic surgeons and oncologists offer robotic radical prostatectomies as one of many possible treatments for prostate cancer.

Radical prostatectomy (prostate removal) is surgery to remove all of the prostate gland and some of the tissue around it. It is done to treat prostate cancer. For almost all prostatectomy surgeries at UF Health, our team utilizes a robotic approach. A robotic radical prostatectomy is a minimally invasive surgical procedure that removes the prostate seminal vesicles and vas deferens, in addition to surrounding lymph nodes in select patients. Sometimes this procedure is called a robotic-assisted laparoscopic prostatectomy, or RALP.

UF Health offers a wide range of robotic technology for prostatectomie. These include:

  • Multi-port surgery, which uses a Da Vinci multi-port robot
  • Single-port surgery, which utilizes the Da Vinci single-port robot

UF Health will soon offer multi-port robotic surgery using the cutting-edge Da Vinci 5 robotic surgical system.

Beyond radical prostatectomy, UF Health is excited to offer various cutting-edge focal therapy options for select patients. Focal therapy is a type of prostate cancer treatment that targets cancerous tissues while leaving normal prostate tissue and surrounding structures unharmed.

What are the benefits of robotic prostatectomy surgery to treat prostate cancer?

Our surgeons use the most advanced robotic system available to improve precision and control. Older techniques, such as open prostatectomy, are rarely used today.

Using the latest technology and equipment combined with our fellowship-trained urologists’ expertise, our prostate cancer surgical approach offers many benefits, these include:

  1. Minimizing the risk of incontinence and impotence
  2. Shorter hospital stays: normally one day or less
  3. Less pain and scarring
  4. Faster recovery: patients return to normal activity in two to three weeks and work in three to four weeks
  5. Reduced blood loss compared to an open prostatectomy

Utilizing a single-port robotic prostatectomy technique has further advantages:

  1. It reduces the number of incisions required.
  2. It regionalizes treatment and is beneficial for surgeries in a very narrow space.

This technique may be used if the surgeon determines it is the best option for the patient.

Other advantages of robotic prostatectomy include:

  1. The high-tech equipment used to accomplish this surgery. There is improved visualization with 10-12 times magnification and a clear view of the internal anatomy due to a specialized stereoscopic endoscope lens connected to a high-definition camera.
  2. Robotic surgeons operate with multi-jointed instruments with the same dexterity as the human wrist.

With these advantages combined, robotic surgery provides better visualization of the critical structures surrounding the prostate gland. It allows surgeons to operate with the same flexibility and ease as a surgeon has when performing an open prostatectomy while at the same time accomplishing this through smaller incisions with significantly reduced blood loss.

Surgical process

How is a robotic prostatectomy performed?

During a multi-port robotic prostatectomy, surgical oncologists carefully insert small, 5-12 millimeter robotic arms—each about the diameter of a dime—into separate small incisions in the patient's abdomen. The arms are equipped with lights, a stereoscopic camera that allows the surgeon and surgical team to view the procedure in three dimensions, and specialized laparoscopic surgical instruments that respond precisely to every movement of the surgeon's hands.

During the procedure, the entire prostate will be removed. Based on the extent and grade of the disease, the surrounding lymph nodes may also need to be removed. Your doctor will discuss this with you before surgery.

What is a robotic nerve-sparing radical prostatectomy?

The extent of the disease and the location of the cancer with respect to surrounding structures will determine if the robotic radical prostatectomy can be a nerve-sparing procedure, known as a robotic nerve-sparing radical prostatectomy. Utilizing this approach will be discussed before surgery, and the ultimate decision to use a nerve-sparing technique will be made during your surgery.

For patients with clinically localized prostate cancer, nerve-sparing robotic prostatectomy provides patients with a safe and minimally invasive technique for removal of the prostate gland while preserving as much of the surrounding nerve structures responsible for penile erections. Furthermore, various methods can be performed to optimize continence.

Overall this minimally-invasive approach, whether single-port or multi-port, boasts the advantage of smaller incisions, reduced pain, less blood loss, transfusion rates, and reduced hospital stay. In select patients with locally invasive or metastatic cancer, morbid obesity, bleeding tendencies, or severe heart or lung problems, robotic prostatectomy may not be advised.

Prostatectomy candidates

What type of patients are candidates for prostatectomy?

Robotic prostatectomy is used to treat patients who have clinically localized prostate cancer. In many centers, including at UF Health, the robotic approach is the treatment of choice for the surgical management of clinically localized prostate cancer.

Who is not considered a good candidate for prostatectomy?

Patients with a history of advanced age, extensive abdominal surgery, radiation, pre-existing heart or lung disease, morbid obesity, or bleeding tendencies may not be the best candidates for robotic prostatectomy. Fortunately, focal therapy or radiation therapy can serve as alternative or additional treatment options.

Patients with known metastatic disease are not candidates for robotic prostatectomy. Patients with recurrent prostate cancer may not be candidates; however, it is best to determine this with your surgeon. Although patients with very large prostate glands can undergo robotic prostatectomy, operative times are generally longer than in patients with smaller prostate gland sizes.

Prostatectomies at UF Health

How long have UF Health surgeons been performing robotic prostatectomies?

Our robotic surgeons have all received extensive advanced fellowship training in robotic surgery. UF Health has performed and trained surgeons in robotic prostatectomies since 2002. Recently, we also began offering outpatient prostatectomies. This allows eligible patients to return home quicker. UF Health takes a multidisciplinary approach to prostate cancer treatment. This includes urologic surgeons, medical oncologists, radiation oncologists, and physical therapists. We offer a wide array of prostate cancer treatments, including:

How long does a prostatectomy take?

Robotic prostatectomy generally takes 2-4 hours, depending on many factors, including the size of the prostate gland, obesity, prior abdominal surgery, and scar tissue. Many of these pre-existing factors mandate a longer operative time. Our surgeons focus on performing a thorough and meticulous surgery, not on the speed of the operation. An additional 2+ hours may be allocated for general anesthesia, setting up the equipment, and coming off of anesthesia.

What happens if complications arise during surgery?

Although extremely rare, conversion to open prostate cancer surgery may be required if difficulty with dissection or extensive bleeding is encountered during the robotic approach.

Our surgeons are trained in open surgical approaches, laparoscopy, and robotic surgery. They are well-equipped to perform prostate surgery in a laparoscopic or open fashion if necessary.

What is the overall success rate in terms of cancer cure for prostate surgery?

The prognosis of cancer-free survival includes many factors. This is based in part upon the grade and stage of your cancer and will be discussed with you by your surgeon following surgery during the review of the pathology report.

After a robotic prostatectomy

What is the potency and continence success rate after prostatectomy?

The timing and extent of return of urinary continence and sexual potency following prostatectomy is a complex process. Some of the factors that influence the success of the return of these quality of life issues include patient factors such as:

  • Age
  • Preoperative urinary and sexual function
  • The presence of medical conditions such as hypertension and diabetes

In addition, surgical factors such as quality and quantity of nerve preservation can influence outcomes.

For patients 60 years old or younger, who were preoperatively potent with no urinary issues and who received bilateral nerve preservation, at 6 months post-surgery, 80% were continent, and 72% were able to participate in intercourse without the use of medication (known as potent). At 12 months post-surgery, 93% were continent, and 85% were potent.

These results can vary significantly depending on individual circumstances, including the extent of cancer, age, and comorbid medical conditions.

What is recovery like after a prostatectomy surgery?

After a period in a recovery room, you will be transported to a hospital room once you are aware and your vital signs are stable. After prostate removal surgery, you may experience:

  • Postoperative pain: Although most patients in the first few days after surgery experience mild discomfort at their incision sites, this is generally well controlled by the use of IV pain medication, a patient-controlled anesthesia pump, or oral pain medication provided by your nurse. You may experience some minor brief shoulder pain (1-2 days) related to the carbon dioxide gas used to inflate your abdomen during the robotic surgery.
  • Hospital Stay: The average hospital stay after a robotic prostatectomy is generally one day (overnight). However, advances in robotic techniques have made it possible to go home the same day, utilizing anoutpatient prostatectomy approach.
  • Nausea: Nausea can occur following any surgery, especially procedures that require general anesthesia. It is usually temporary and controlled by medication, which your nurse can administer as needed.
  • Urinary catheter: A urinary catheter (also called foley catheter) is placed to drain your bladder during surgery while you are asleep. This is in an effort to monitor your urine output following surgery. Upon awakening from anesthesia, patients often notice an urge to urinate as a result of the catheter. This sensation often resolves with time. It is not uncommon to have blood-tinged urine for a few days after your surgery while your catheter is in place.
  • Bladder spasms: Frequently, after prostate surgery, the bladder becomes irritated and undergoes frequent contractions called bladder spasms. These can be felt as intermittent sharp shooting pain or spasms in the lower abdomen. Often, with time alone, these spasms resolve. On occasion, an antispasmodic can be provided if severe spasms occur.
  • Pelvic drain: In some prostatectomy surgeries, a small clear tube called a Jackson Pratt or JP pelvic drain will be placed during surgery, exiting out of the side of your pelvis. The drain output often will appear blood-tinged. The drain primarily serves to identify any excessive bleeding, lymphatic lea,k or urine leak from the anastomosis. The drain remains in place for one week after surgery and is to be removed in the clinic at your first postoperative visit.
  • Diet: Your diet will be advanced slowly following surgery from liquids to solids as tolerated. It is often the case that your appetite will be poor for up to a week following surgery. In addition, your intestinal function is often sluggish due to the effects of surgery and general anesthesia. For these two reasons, we recommend taking only small amounts of liquids by mouth at any time until you begin to pass gas and your appetite returns. In the meantime, your intravenous catheter will provide the necessary hydration to your body as your oral intake improves.
  • Constipation/gas cramps: Due to the anesthesia, you may experience some constipation for several days following surgery. Suppositories and stool softeners are usually given to help with this problem. Taking a teaspoon of mineral oil daily at home will also help prevent constipation.
  • Fatigue: Fatigue is common following surgery and should subside in a few weeks after surgery.
  • Mobility: On the evening of surgery, it is essential to get out of bed and begin walking under the supervision of your nurse or family member to help prevent blood clots from forming in your legs. You can also expect SCDs (sequential compression devices) wrapped around your lower legs and calf area to prevent blood clots called deep vein thrombosis from forming in your legs. In the days that follow surgery, patients are advised to walk at least 6 separate times a day in the hallways. This helps reduce the chance of deep vein thrombosis and speeds the return of bowel function.

After being discharged from the hospital, patients can expect the following:

  • Pain control: For the majority of patients, one to two days of prescribed oral pain medication may be necessary, after which acetaminophen or ibuprofen is usually sufficient to manage their pain.
  • Showering: Patients can shower immediately upon discharge from the hospital, allowing their incisions to get wet. Once out of the shower, dry your incision sites and avoid heavy creams or lotions. Tub baths or hot tubs in the first 2 weeks are discouraged as this will allow for prolonged soaking of your incisions and increase the risk of infection. You may shower after returning home from the hospital. Your wound sites can get wet but must be patted dry immediately after showering. The sutures underneath the skin will dissolve in 4-6 weeks.
  • Activity: Walking 6 times a day for the first 2 weeks after surgery on a steady surface is strongly encouraged as prolonged sitting or lying can increase your risk of pneumonia and deep vein thrombosis. It is okay to climb stairs, however please avoid any heavy lifting or exertion for up to 4 weeks following surgery. Patients may begin driving once they are off of narcotic pain medication and have full range of motion at their waist. Most patients can return to full activity, including work, on an average of 3-4 weeks after surgery.
  • Physical therapy: At UF Health, as a part of the robotic prostatectomy pathway, is an automatic referral to a pelvic floor physical therapist who will guide you on techniques to improve continence.
  • Diet: Patients may resume a regular diet once they pass gass and their appetite improves.
  • Erectile function: Following a prostatectomy, patients may experience erectile dysfunction. However, some function may be regained depending on the extent of the disease, nerve damage, or other health conditions. Some possible treatments, such as prescription medication, pump devices, implants, and rehabilitation, may help. Should you experience erectile decline that is non-satisfactory, we have highly specialized urologists who can help manage select post-prostatectomy patients with erectile dysfunction. Any changes to sexual function will be discussed with your urologic surgeon before surgery.
  • Follow-up appointment: Patients are routinely scheduled for a follow-up appointment at UF Health Urology approximately one week after surgery to have the catheter removed.
  • Pathology results: The pathology results from your surgery are usually available one week following surgery and will be discussed with you at your first postoperative appointment. A copy of your pathology report will be provided to you at this time.

Will I need further prostate cancer treatment after a prostatectomy?

For patients with organ-confined prostate cancer that has not spread beyond the prostate capsule or into the lymph nodes or seminal vesicles, the prognosis remains excellent as most are cured with surgery alone.

In cases where more invasive or metastatic disease is found, additional treatments, such as radiation, chemotherapy, and hormonal therapy, may be required. These options are decided on a case-by-case basis.

UF Health offers a multi-disciplinary meeting for challenging cases of prostate cancer. There are clinical trials with chemotherapy and vaccine therapy that are available at our institution for cases of metastatic prostate cancer that are refractory to conventional treatments. These would be administrated under the advisement of a medical oncologist.

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