Q:  What is a daVinci Prostatectomy (dVP)?

A:  The Ventura Community Hospital is one of a few U.S. hospitals offering a new, less invasive alternative to traditional surgery for removing prostate cancer. The dVP is a minimally invasive radical prostatectomy.

 

Q:  How is dVP different from open radical prostatectomy?

A:  In contrast to open radical prostatectomy that does require an abdominal incision, the dVP uses ports, most of which are no longer than a half inch. The Ventura Community Hospital surgeons then insert slender instruments through these small ports, including a computerized scope, allowing them to view a magnified image in real time. The surgeons utilize advanced technology to visualize and remove the cancerous prostate with the “nerve sparing” technique. The dVP and open radical prostatectomy both remove the entire prostate, and then attach the urethra directly to the bladder. In excision and reconstruction, therefore, the dVP and open radical prostatectomy are the same.

Q:  What is the robotic assisted laparoscopic prostatectomy?

A:  The Ventura Community Hospital now offers the new da Vinci® surgical system, allowing our surgeons to improve on the technique of dVP. The laparoscopic technique provides unparalleled surgical accuracy, to enhance the preservation of nerves, significantly reduce blood loss, and improve restoration of the lower urinary tract.

Q:  How does robotic assisted laparoscopic prostatectomy work?

A:  With the state-of-the-art da Vinci® computer-enhanced minimally invasive surgery system, the Ventura Community Hospital surgeons perform the same procedure done in a conventional prostatectomy, but are aided by a three-dimensional computer vision system to manipulate four robotic arms. A pencil-size video camera held by one of the arms is inserted through an incision to provide magnified 3D images of the surgical site. The 3D view helps the surgeon more easily identify the delicate nerves and muscles surrounding the prostate. The robotic arms can rotate a full 360 degrees, allowing the surgeon to manipulate surgical instruments with greater precision, flexibility and range of motion.

Q:  What are the benefits of dVP?

A:  Patient’s incisions heal faster and there is a quicker recovery time. A traditional open radical prostatectomy requires two days hospitalization and recovery lasting about 2-3 months. With daVinci Prostatectomy and robotic assisted surgery the recovery time is as little as two weeks – a greater than 50 percent reduction in recovery time.

Q:  Who is a candidate for robotic-assisted dVP?

A:  Anyone diagnosed with localized prostate cancer may benefit from robotic-assisted dVP. However, the decision to have prostate cancer treated surgically revolves around numerous considerations. Variables that enter into preoperative evaluation include age, pre-biopsy PSA, biopsy findings, previous prostate cancer treatments, other illnesses, smoking history, previous surgery, and current medications. dVP can be done for men of all sizes and shapes. dVP can sometimes be done in men who have had other operations: appendectomy, laparoscopic hernia repair, repair of abdominal trauma, etc.

Q:  Does dVP remove the whole prostate?

A:  Yes. dVP removes the prostate, seminal vesicles, ends of the vas deferens, and depending on oncological considerations, nerve bundles and/or lymph nodes.

Q:  Why is there less blood loss with dVP?

A:  The reduction in blood loss reflects the improved view of the operative field, especially behind the pubic bone, home of the venous plexus of Santorini. The improvement in view comes from using a lens that tracks directly into the operative field where the remote human eye has a hard time going. The dVP also uses magnification and bright illumination. Overall, this improved view permits a more precise and gentle dissection which means better control of potential sources of bleeding. Furthermore, the CO2 pressure probably compresses some of the smaller veins, which themselves are low-pressure systems.

Q:  Does robotic assisted dVP require general anesthesia?

A:  Yes. Robotic assisted dVP is considered major surgery and thus requires general anesthesia with full intubation.

Q:  Does prostate size matter?

A:  As a practical matter, prostate size is not much of an issue. We routinely remove prostates ranging from 10 to 100 ccs in size. 

Q:  Can lymph nodes be removed with dVP?

A:  Yes. Lymph nodes, to which prostate cancer may spread, can be removed during a robotic-assisted dVP.

Q:  What are the risks of dVP?

A:  dVP is major surgery, done under general anesthesia and carrying the general risks of any major operation, including heart attack, stroke, and death. Robotic-assisted dVP is also associated with the risks of infertility, rectal injury, impotence, and incontinence.

Q:  Can the neurovascular bundles be preserved?

A:  Yes. The neurovascular bundles whose preservation is associated with the likelihood of maintaining erections can be preserved. Nerve preservation does not guarantee satisfactory erections after surgery.

Q:  Does it make sense to preserve the neurovascular bundles?

A:  Not in all cases. The issue here relates to the physical proximity of the bundles to areas of malignancy, which can microscopically extend beyond the prostate and into the bundles. The decision to preserve one or both neurovascular bundles depends on each individual.

Q:  When will the ability to have an erection be regained following surgery?

A:  Return of potency depends on many physical and psychological factors including preoperative erectile function and type of surgery (such as unilateral or bilateral; nerve-sparing or non-nerve sparing). Function may return spontaneously as nearly as one week after surgery, or with the aid of medications (Viagra, Muse). Potency rehabilitation may take up to 6 to 12 months to return.  Factors that can interfere with erectile function include hypertension, diabetes, obesity, atherosclerosis, history of smoking, and anxiety, among others.

Q:  Are venous compression devices used in this surgery?

A:  Yes. As a precaution against developing blood clots, each patient has venous compression devices placed prior to surgery. These are removed when the patient becomes ambulatory.

Q:  Does dVP require a catheter, drain, dressings, or stitches?

A:  Yes. Like any radical prostatectomy, robotic assisted dVP requires reconstruction of the bladder-urethra connection. A catheter is left in the urethra, connected to a drainage bag, and used to align the healing suture line and drain the bladder. In the immediate post-op period, robotic assisted dVP also requires a drain that goes through the abdominal wall and left in the pelvis behind the pubic bone. The drain assures the collection of blood and urine that may accumulate immediately after surgery, and is removed when the output drops, usually prior to leaving the hospital. There are stitches, but these dissolve by themselves and require no special care. The surgical dressings are five Band-Aid type dots used to cover the instrument entry sites. These dressings are generally removed 48 hours after surgery.

Q:  How long should the catheter stay in?

A:  We routinely remove the catheter in five to seven days at the first follow-up visit.

Q:  What can I expect after the catheter comes out?

A:  Almost all patients have some incontinence when the catheter comes out. Incontinence varies from person to person, but usually improves significantly or resolves by the one-month follow-up clinical visit. Continence function returns with time, and patience here is a real virtue.

Q:  How can I speed my continence recovery?

A:  You will be given an instruction sheet for Kegel exercises and other suggestions that will help in the recovery of continence.

Q:  Can I bathe after dVP?

A:  Yes. Most patients may shower within 24 hours of surgery.

Q:  What can I expect immediately after robotic assisted dVP?

A:  Patients leave the operating room with an intravenous line, a urethral catheter, and a small rubber drain in their lower abdomen. After recovering from anesthesia, almost all patients are on clear liquids the next day. In the first few hours, depending on strength and motivation, most patients get out of bed and stretch their legs, and begin walking by nightfall. Most leave the hospital within 48 hours. Patients are discharged with a catheter connected to a leg bag, which fits under their pants. Loose clothing and shoes that do not require tying seem easier to handle in the first few days.

Q:  What can I expect after getting home?

A:  While relative to open surgery the dVP is generally less demanding, the experience is still demanding. The single most common complaint after hospital discharge seems to be sleep deprivation and fatigue. Most patients are anxious going into surgery, get little sleep the night before surgery, arrive at the hospital very early on the morning of surgery, and get very little sleep the night after surgery. Accordingly, most patients look forward to a good, long nap and a shower after getting home. The other major complaint seems to be a sense of bloating with clothes fitting very tight. This bloating seems related to the effects of surgery, anesthesia, and bed rest on intestine function. Often this sensation responds well to walking, which helps the patient expel intestinal gas, which in turn helps the patient regain his overall comfort and appetite.

Q:  If I live far away, can I travel after surgery?

A:  Many of our patients come from far away and we can help with numerous logistical issues related to travel, from finding a suitable hotel to arranging medical evaluations pre-operatively.

Q:  Must I return for follow up care?

A:  Yes. We see patients at one and three weeks post-op. WE check them monthly until the PSA drops to 0.00, they are completely continent, and functioning sexually.

Q:  What happens to my medical records and who will take care of me when I get home?

A:  We work with patients to transmit any and all relevant medical data to their family physicians. We continue caring for all local patients.

Q:  What is the long-term follow-up after dVP?

A:  Depending on the pathologist’s report of the dVP specimen, a patient may or may not consider additional cancer treatments. In most cases, but not all, the wise course of action is surveillance: periodic measurement of blood PSA, thought to be the most sensitive indicator of cancer recurrence.

 

The information above was compiled from Ventura County Medical Urology Group, City of Hope Urology, & Intuitive Surgical.

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2807 Loma Vista Rd., Ste. 101
Ventura, CA 93003

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